A Study of non invasive positive pressure ventilation for acute exacerbation of chronic obstructive pulmonary diseases: Its efficacy and safety
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 1
Abstract
Aims and objectives: To determine the effectiveness and safety of non-invasive positive pressure ventilation (NIPPV) in acute exacerbation of chronic obstructive pulmonary disease. Materials and method: Fifty patients with acute exacerbation of chronic obstructive pulmonary disease leading to hypoxemia and respiratory acidosis with pH < 7.35 and PaCO2 > 45 mm of Hg admitted to the intensive care unit (ICU) were eligible for inclusion in the study. Noninvasive ventilation was administered with the use of portable non-invasive ventilator VPAP II. Data for heart rate, respiratory rate, arterial blood gases (pH, PaO2, PaCO2) at baseline, one and six hours was recorded. The primary outcome was the need for endotracheal intubation during the intensive care unit (ICU) stay. Results: The mean age of study patients was 52.6±14.2years. The male:female ration was 2.13:1. The mean BMI was 22.3± 3.7 with APACHE II of 19.3±2.9. It was seen that after one hour there was significant improvement in respiratory rate and heart rate, pH, PaCO2 levels, PaO2 levels and O2 saturation parameters in patients successfully managed with NIPPV. After six hours also there was significant improvement in the clinical and arterial blood gas parameters as compared to baseline parameters. When the levels of parameters after six hour were compared with levels after one hour it was observed that the improvement in respiratory rate, heart rate, pH and O2 saturation was statistically significant. However the difference in PaO2 and PaCO2 levels was not statistically significant. The mean duration of NIPPV was 18.3± 9.2hrs. The average duration of ICU stay was 2.8±2.1days whereas the mean duration of hospital stay was 4.1±1.9days. Successful Outcome was observed in 43 (86%) patients. Conclusion: In patients with exacerbation of chronic obstructive pulmonary diseases, non invasive positive pressure ventilation leads to rapid improvement in blood gas parameters and reduces the need for ETI. Thus it is effective and safe for use in patients of chronic obstructive pulmonary diseases with acute exacerbation.
Authors and Affiliations
Gunadhar Padhi, Aklesh Tandekar, Nitin Rathod
Keywords
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