Study of indications, associated comorbid condi-tions and outcome of patients requiring Bilevel type of Non Inva-sive Positive Pressure Ventilation in a tertiary care hospital

Abstract

BiLevel non-invasive positive pressure ventilation (BiPAP) is the most utilised supportive treatment in the world of medicine for respiratory failure. COPD is the most common indication for its use. We in-vestigated the indications and effects of comorbidities on BiPAP outcomes because there have been few studies on it. It is a descriptive, observational, cross-sectional study conducted over period of 12 months, wherein 60 patients fulfilling the inclusion criteria for the requirement of BiPAP were includ-ed in the study and evaluated. The indications, associated comorbid conditions and the outcomes of NIV therapy were studied. COPD exacerbation with Type II Respiratory failure was the most common indication (71.4%), followed by asthma [near fatal/severe] (21.4%). Success with BiPAP in COPD was 67.6% . In COPD patients with co-morbidities, success came down to 47.4%. Pneumonia, ILD & Cardiogenic Pulmonary Edema (CPE) had success rates of 0%, 16.7% and 66.7% respectively with BiPAP therapy,with higher mortality rates for pneumonia and ILD. Comorbidities were present in 51.7% of patients and Hypertension (35%) and Diabetes Mellitus (21.7%) were the most common. In patients who had co-morbidities, the mean hospital stay was 12 days, which was higher than the mean hospital stay of 9.3 days in patient with no co-morbidities. The presence of co-morbidities was associated with higher failures with BiPAP (51.6%) comapred to ones with no co-morbidities (13.8%) (p value <0.05). Higher respiratory rate (>28/min), lower ABG pO2, pCO2 and bicarbonate levels and higher blood glucose and total leucocyte counts were associated with higher BiPAP failures and mortality. The conclusion was that the most common indication of BiPAP was a COPD exacerbation with type II respiratory failure and presence of comorbidities led to a poorer outcome with prolonged hospital stay. ABG parameters, blood glucose levels and total leucocyte counts has an effect on NIV outcome and mortality.