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Category: Volume 07 Issue 02 February 2019
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Title: Success of NIV in Acute exacerbation of COPD and Factors Associated with Failure- A Cross Sectional Study in a Tertiary Care Centre

Authors: Anitha Thilakan, Anithakumari K, Reshmi S Nair, Sanjeev Nair

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.52

Abstract

Background: Non invasive ventilation has been helpful in managing COPD patients presenting with Acute exacerbations. This study tries to find out the success rate and factors associated with failure of NIV in AECOPD with Acute or chronic respiratory failure.

Methods: COPD Patients admitted with acute or chronic respiratory failure to the Intensive respiratory care unit started on NIV BiPAP mode using ICU ventilator were enrolled into the study. Patients were followed up till either they were weaned off NIV or ended up with intubation. Patients were followed up with serial ABGs and intense clinical monitoring according to Department protocol.

Setting: Department of Pulmonary Medicine, Govt Medical College Thiruvananthapuram.

Result: NIV was successful in 72% of patients with Acute exacerbation of COPD. Patients with an initial  low respiratory rate, high GCS score ans less severe airflow obstruction had a better outcome with NIV. An improvement in the blood gas values within the first 1 hr of initiating NIV contributed to a successful final outcome.

Conclusion: When initiated sufficiently early Non Invasive ventilation is a better choice in acute exacerbations of COPD with respiratory failure. Carefull patient selection leads to better outcome and reduces complications.

Keywords: Chronic Obstructive Pulmonary Disease, Acute Exacerbation, Non invasive ventilation, Respiratory failure.

References

  1. Global Initiative for Obstructive Lung Disease-Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease:2018 report
  2. Terence A. R. Seemungal, Gavin C. Donaldson, Elizabeth A. Paul, Janine C. Bestall, Donald J. Jeffries, And Jadwiga A. Wedzicha. Effect of Exacerbation on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease .Am J Respir Crit Care Med .Vol 157. pp 1418–1422, 1998
  3. Non-invasive ventilation in acute respiratory failure. British Thoracic Society Standards of Care Committee. Thorax 2002;57:192–211
  4. Ambrosino N. Noninvasive mechanical ventilation in acute on chronic respiratory failure: determinants of success or failure. Monaldi Archives for Chest Disease 1997;52(1):73–75.
  5. Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure .American Journal of Respiratory & Critical Care Medicine 1995;151(6):1799–1806.
  6. Stephan Budweiser, Rudolf A Jörres, Michael Pfeifer. Treatment of respiratory failure in COPD. Int J Chron Obstruct Pulmon Dis. 2008 Dec; 3(4): 605–618.
  7. S Putinati,L Ballerin, M Piattella, L Panella, A Potena. Is It Possible To Predict The Success Of Non-Invasive Positive Pressure Ventilation In Acute Respiratory Failure Due To Copd?.Respiratory Medicine October 2000volume 94, Issue 10, Pages 997–1001
  8. D Chiumello,G Conti,G Foti,M Giacomini Matteo, A Braschi, G Iapichino.Non Invasive ventilation outside the intensive care unit for Acute Respiratoty Failure. Minerva Anaestesiol 20009;75:459-66
  9. Confalonieri, G.Garuti, M.S. Cattaruzza, J.F. Osborn, M.Antonelli, G. Conti.A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J 2005; 25: 348–355.DOI: 10.1183/09031936.05.00085304
  10. Annalisa Carlucci, Jean-Christophe Richard, Marc Wysocki, Eric Lepage, Laurent Brochard And The Srlf Collaborative Group On Mechanical Ventilation .Noninvasive Versus Conventional Mechanical Ventilation An Epidemiologic Survey .Am J Respir Crit Care Med Vol 163. Pp 874–880, 2001
  11. P K Plant, J L Owen,M W Elliott. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome Thorax 2001;56:708–712
  12. Maurizio Moretti, Carmela Cilione, Auro Tampieri, Claudio Fracchia, Alessandro Marchioni, Stefano Nava .Incidence and causes of non-invasive mechanical ventilation failure after initial success. Thorax 2000;55:819–825
  13. Ritesh Agarwal, Rajesh Gupta, Ashutosh N, Aggarwal, Dheeraj Gupta. Noninvasive positive pressure ventilation in acute respiratory failure due to COPD vs other causes: Effectiveness and predictors of failure in a respiratory ICU in North India. International Journal of COPD 2008:3(4) 737–743
  14. Josephine V Lightowler, Jadwiga A Wedzicha, Mark W Elliott, Felix SF Ram. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ Volume 326 25 January 2003 bmj.com
  15. Helmy Haja Mydin, Stephen Murphy, Howell Clague, Kishore Sridharan, Ian K Taylor. Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease. International Journal of COPD 2013:8 151–157
  16. Char-Wen Chen,Yih-Yuan Chen,Chin-Li Lu, Solomon Chih-Cheng Chen,Yi-Jen Chen, Ming-Shian Lin,Wei Chen. Severe hypoalbuminemia is a strong independent risk factor for acute respiratory failure in COPD: a nationwide cohort study. International Journal of COPD 2015:10 1147–1154
  17. M. Mclaughlin, I.M. Murray , G. Thain And G.P. Currie.Ward-based non-invasive ventilation for hypercapnic exacerbations of COPD: a ‘real-life’ perspective. Q J Med 2010; 103:505–510. doi:10.1093/qjmed/hcq063
  18. Antonio Anto´ n, MD; Rosa Gu¨ ell, MD; Juan Go´mez, MD; Jose´ Serrano, MD; Abilio Castellano, MD; Jose Luis Carrasco, BSC; and Joaquı´n Sanchis, MD. Predicting the Result of Noninvasive Ventilation in Severe Acute Exacerbations of Patients With Chronic Airflow Limitation. CHEST / 117 / 3 / March, 2000;828-33
  19. Laurence Vignaux,Frédéric Vargas,Jean Roeseler, Didier Tassaux, Arnaud W. Thille, Michel P. Kossowsky, Laurent Brochard, Philippe Jolliet. Patient–ventilator asynchr-ony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Medicine. May 2009, 35:840
  20. Irfan Ucgun, Muzaffer Metintas, Hale Moral, Fusun Alatas, Huseyin Yildirim, Sinan Erginel. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respiratory Medicine Volume 100, Issue 1, January 2006, Pages 66-74
  21. Contou D, Fragnoli C, Córdoba-Izquierdo A, Boissier F, Brun-Buisson C, Thille AW. Non invasive ventilation for acute hypercapnic respiratory failure: intubation rate in an experienced unit. Respir Care. 2013 Dec;58(12):2045-52. doi: 10.4187/respcare.02456.
  22. Ingrid L Titlestad, Annmarie T Lassen, Jørgen Vestbo.Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure.Int J Chron Obstruct Pulmon Dis. 2013; 8: 215–219. doi: 2147/COPD.S42632
  23. J V J Lightowler, M W Elliott.Predicting the outcome from NIV for acute exacerbations of COPD .Thorax2000;55:815–816

Corresponding Author

Dr Anitha Thilakan

Asst Professor, Dept of Pulmonary Medicine,Govt Medical College Ernakulam

HMT Colony PO, Kalamassery, Ernakulam, Kerala PIN-683503, India

Ph: 9497265709, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.