Outcome of early use of non-invasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.

Nadia Ishfaq,Naheed Gul,Neelum Zaka

doi:10.12669/pjms.35.6.857

Abstract

Objective:To determine the outcome of early use of non-invasive positive pressure ventilation (NIPPV) in Pakistani patients with acute exacerbation of chronic obstructive pulmonary disease.Methods:This descriptive study was conducted at Shifa International Hospital Islamabad from April 2015 to January 2017. A total of 120 patients with acute exacerbation of chronic obstructive pulmonary disease receiving NIPPV alongside standard therapy were included in the study. The patients were clinically assessed before starting on NIPPV. The parameters of respiratory rate, pH and paCO2 were monitored and NIPPV was given for six hours to evaluate clinical outcomes and analyze the factors predicting failure (requirement of mechanical ventilation and mortality). Frequency and percentages were calculated for qualitative variables while Mean and Standard Deviation for quantitative variables. Chi-square and t-test were used to see differences in pre and post NIPPV arterial blood gases.Results:Patients’ mean age was 58.88±10.09 years. Males were 88 (73.3%) and females were 32 (26.7%). The mean respiratory rate was 24±1.45 per minute before and 17.96±1.35 per minute after NIPPV (p < 0.00001). The mean pH before NIPPV was 7.27±0.04 and afterwards 7.38±0.02 (p < 0.00001). The mean pCO2 was 61.87±9.60 mm of Hg before and 57.46±6.79 mm of Hg after NIPPV (P < 0.0003). Twenty Four (20%) patients required invasive ventilation of which 19 (15.8%) patients could not survive.Conclusions:There was remarkable improvement in the arterial blood gases after NIPPV. However, the high mortality rate and significant number of COPD patients requiring mechanical ventilation necessitates further investigation into our population.

Highlights

Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive partly reversible air flow limitation and lung hyperinflation with major extra pulmonary manifestations and co-morbid conditions.[1]
We investigated the effects on arterial blood gases (ABGs) for comparison to previous studies in Pakistan
We studied the effect of non-invasive positive pressure ventilation (NIPPV) on respiratory rate, arterial blood gases, the number of patients who could be discharged home safely, the need for mechanical ventilation and mortality rate in patients with acute exacerbation of COPD

Summary

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive partly reversible air flow limitation and lung hyperinflation with major extra pulmonary manifestations and co-morbid conditions.[1]. WHO, the number of COPD cases worldwide will increase by three times the total number of COPD cases by the year 2020.1. COPD exacerbation is characterized by the deterioration of patient’s baseline symptoms including dyspnea, cough and/or sputum which usually requires change in regular medication.[1] An acute exacerbation of COPD is the main source of admission to hospitals.[5] A portion of these patients with frequent exacerbations may develop acute respiratory failure requiring Intensive Care Unit (ICU) admission and utilization of large ICU resources.[6]

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