Comparison between continuous positive airway pressure and bilevel positive pressure ventilation in treatment of acute exacerbation of chronic obstructive pulmonary disease

Abstract

In the management of COPD with respiratory failure two types of non invasive ventilation, continuous positive airway pressure and bilevel positive airway pressure (CPAP and BIPAP) were emerged with the aim of correcting gas exchange abnormalities and avoiding endotracheal intubation. Aim of the workTo evaluate and compare the effectiveness of 2 types of noninvasive respiratory support systems, continuous positive airway pressure, and bilevel positive pressure ventilation in treatment of acute exacerbation of chronic obstructive pulmonary disease:This study included 60 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) (48 males and 12 females) with age ranged from (51 to 69years) admitted in Chest Department and Respiratory Care Unit in Chest Department Sayed Galal University Hospital, Al Azhar University during the period between May 2011 and February 2012. These patients fulfilled the diagnostic criteria for COPD patients with acute respiratory failure with exclusion of patients presenting with any of exclusive criteria for non invasive ventilation.Patients were classified randomly into 3 groups.1. Group 1 (CPAP group): included 20 patients treated with standard therapy plus respiratory support with CPAP using the apparatus (VPAP III ST-A with QuickNav) and use a Res Med mask.2. Group 2 (BIPAP group): included 20 patients treated with standard therapy plus respiratory support with CPAP using the apparatus (VPAP III ST-A with QuickNav) and use a Res Med mask.3. Group 3 (standard group): Included 20 patients treated with controlled oxygen therapy, antibiotics, bronchodilators, corticosteroids, anticoagulant and other medications needed for the patient.All patients were subjected to history taking, clinical examination, routine laboratory investigations, chest X-ray, ECG and blood gasses analysis. ResultsThis study revealed the following:• Clinical assessment at time of admission revealed non significant difference between the three groups as regard respiratory rate, pulse, systolic and diastolic blood pressure (SBP and DBP) and consciousness level at time of admission with p value 0.767, 0.252, 0.350, 0.441and 0.817 respectively and there was no statistically significant difference between the three groups as regard Pa02, PaC02, 02 saturation and pH with p value 0.127, 0.077, 0.098 and 0.998 respectively.• In group 2 (BIPAP group):- There was improvement in the arterial Pa02 in comparison to group 1 and 3 after 1, 6, 12h and on second day with significant improvement especially after 6, 12h and in second day with p value 0.013<0.001 and 0.012 respectively.- There was significant improvement in the arterial PaCO2 in comparison to group 1 and 3 after 1, 6, 12h and on second day with p value 0.000, 0.000, 0.012 and 0.002 respectively.- There was improvement in 02 saturation in comparison to group 1 and 3 after 1, 6, 12h and on second day with significant improvement especially after 12h and on second day with p value 0.0492 and 0.041 respectively.- There was mild improvement in arterial pH in comparison to group 1 and 3 with significant improvement especially after 12h with p value (0.001).• As regard duration of stay in ICU, there was less duration of stay in both groups 1 and 2 in comparison to group 3 with decrease, but non significant, in duration of stay in ICU in group 2 in comparison to group 1.• Finally group 2 (BIPAP group) had significant statistical difference in avoiding endotracheal intubation ETI in comparison to group 1 and 3 with p value (0.033). ConclusionBIPAP has a superior efficacy in correcting gas exchange abnormalities and avoiding endotracheal intubation than CPAP.