Noninvasive tri-level positive airway pressure ventilation: is it a new challenging mode in management of patients with chronic obstructive pulmonary disease?

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a serious issue of sickness and rise in global fatality rates. Noninvasive positive pressure ventilation is the first-line therapy in patients with COPD with respiratory fialure (RF). Tri-level positive airway pressure (Tri-PAP) is new challenging mode of noninvasive ventilation (NIV). Objectives To compare between two modes of noninvasive positive pressure ventilation [bi-level positive airway pressure (Bi-PAP) and Tri-PAP] and to spell out outcomes, complication, and predictors of favorable outcome of NIV in patients with COPD with respiratory failure. Patients and methods This prospective comparative study was accomplished on 30 patients with COPD with respiratory failure, who were subjected to NIV (Bi-PAP or Tri-PAP) and standard conventional therapy. Arterial-blood gases (ABGs) (initially, 6 h, and finally) were analyzed. NIV outcomes, complications, and predictors of success were encountered. Results Patients were categorized according to managerial therapeutic NIV into Bi-PAP (n=15) or Tri-PAP (n=15) groups. Initial, 6-h, and final ABGs analyses (pH, PO2, PCO2, HCO3, and O2 sat) and NIV outcomes (successful or failed weaning) were analogous, without considerable variation between both Bi-PAP and Tri-PAP groups. pH showed crucial advancement after 6 h of initiation of Tri-PAP NIV. Terminal ABG interpretation (pH, PaCO2, PaO2, and O2 sat) had better outcomes than initial and 6-h ABG analyses of Tri-PAP NIV group. Irritations and ulcerations of nasal bridge, dry nose or mouth, nasal congestion, hypotension, and PaCO2 increase were the most hazardous events in both Bi-PAP and Tri-PAP NIV groups. Shorter duration of NIV, lower BMI, higher pH, and lower PCO2 (initially, 6 h, and final ABGs) as well as higher O2 saturation (in final ABG) were predictors of successful weaning in NIV (Bi-PAP and Tri-PAP) groups collectively. Conclusion Bi-PAP and Tri-PAP are appropriate mode of NIV in patients with COPD with RF with minimal complication and better outcomes. Tri-PAP had no superiority of utilization than Bi-PAP mode. pH and PCO2 are the powerful predictors of favorable NIV outcomes.