EFFECT OF NONIVASIVE POSITIVE-PRESSURE VENTILATION ON OUTCOME IN PATIENTS WITH ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Non-invasive positive pressure ventilation (NiPPV) is known to be effective in hypercapnic respiratory failure. However, some uncertainty still exists regarding its use in certain subgroups of patients with main consideration that, if ineffective, NiPPV delays time to intubation and may worsen the outcome. 58 subjects with acute exacerbation of COPD, resulting in ICU admission, were included into the randomized, single-blind, controlled study. Study group was treated with NiPPV in PSV or BiLevel mode and increased FiO2, control group – with O2 therapy only. Medical therapy was prescribed to study participants regardless of their group allocation. Rate of tracheal intubation in study group was 7 (25 %) compared to 20 (67 %) in control group (p<0,0001). Relative risk reduction (RRR) was 61,5 % (95 % CI 23-80 %) and absolute risk reduction for study group was 42,0 % (95% CI 17,6-62). Mortality rate in the control group was 36.6 % (11 deaths), while in the study group the mortality rate was 21.4 % (6 deaths). Relative risk of death for the study group in comparison with the control group was found at the level of 0.56 (95 % CI 0.25 – 1.29). Relative risk of death reduction was 43.4 % (95% CI 28.7 – 75.1). Absolute risk of death reduction was 15.2 % (95% CI 5.39 – 38.2). The hospital lengths of stay in the study group was 20.8±11.3 days, in the control group 29.1±12.3 days (p=0.063). Regarding ICU length of stay, no significant difference was found between the groups: 14.7±12.2 days and 10.8±7 days in the control and study groups, respectively (р=0.178).
 Conclusion: we found evidence in favor of efficacy of NiPPV in COPD patients with acute exacerbation in terms of mortality and tracheal intubation. No difference in hospital and ICU length of stay was found. No evidence of additional risk, related to NiPPV, were found.