Non-invasive ventilation in the emergency department for patients in type II respiratory failure due to COPD exacerbations

2015 ◽  
Vol 23 (3) ◽  
pp. 232-236 ◽  
Author(s):  
Abigail Moxon ◽  
Geraldine Lee
Author(s):  
Shahid M. Patel ◽  
Girija P. Nair ◽  
Balaji G. Tuppekar ◽  
Abhay G. Uppe

Background: Assess the use of non-invasive ventilation as an alternative way for ventilation in acute respiratory failure, determine factors that can predict the successful use of NIV, evaluate factors hindering success of NIV.Methods: Thirty hospitalised patients fulfilling inclusion criteria, diagnosed with Type II Respiratory Failure on ABG were recruited after obtaining an informed written consent. Complete history and detailed physical examination were followed by routine investigations.Results: Comparison of the pH on admission with the pH after 1st hour of NIV, the latter showed statistically significant improvement. Drop in PaCo2 and rise in PaO2 on ABG from admission and after stopping NIV was statistically significant. Patients with lower MMRC grade and severe cough showed significant improvement in pH, however patient with higher emergency visits and past hospitalisation showed less improvement in pH, after 1 hour of NIV therapy. A total 4 patients were intubated, with mean pH of 7.22, 3 out of them had higher emergency visits, 2 out of them had ICU admission.Conclusions: NIV treatment for COPD with type II respiratory failure avoids intubation, reduces complications and should be considered as first line therapy instead of ET intubation. Lower mMRC grade, lesser hospitalizations, lesser emergency visits, higher BMI, symptoms like cough, can have a positive predictive value for the outcome of NIV.


2020 ◽  
Vol 27 (05) ◽  
pp. 1027-1031
Author(s):  
Muhammad Atiq ul Mannan ◽  
Muhammad Imran Shahzad ◽  
Muhammad Waqas Afzal ◽  
Humayoun Ghulam Murtaza ◽  
Muhammad Waseem ◽  
...  

Objectives: To determine the “frequency of ‘success’ of non-invasive ventilation (NIV) among patients with type II respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD)”. Study Design: Cross sectional Study. Setting: Department of Pulmonology Nishtar Hospital Multan. Period: March 2016 August 2016. Material & Methods: A total of 101 study cases meeting inclusion and exclusion criteria of this study were registered using non probability consecutive sampling technique. Arterial samples for arterial blood gases (ABG) were sent. Base line pH and pcO2 were measured. All the patients were offered with NIV for 12 hours. After 12 hours, ABG was again measured to see any improvement in pH and pCO2. Success as labeled as ‘yes’ if pH > 7.35 and pCO2 is < 60 mm of Hg. The patients were discharged and follow up time was adjusted. Results: Out of these 101 study cases, 53 (52.5 %) were male and 48 (47.5 %) were female patients having mean age 61.50 ± 10.77 years. Mean duration of disease was 8.54 ± 5.26 years. Mean BMI levels of our study cases was 23.31 ± 2.18 Kg/m2. Mean baseline pH value was 7.32 ± 0.016. Mean baseline pCO2 value was calculated to be 67.56 ± 6.05 mmHg. Mean pH value at 12 hours after NIV was 7.37 ± 0.02. Mean pCO2 value at 12 hours after NIV was calculated to be 51.32 ± 6.30 mm Hg. Success was achieved in 98 (97%) of our study cases. Success was stratified with regards to gender, age, BMI and duration of disease and p values calculated were found to be p=1.00, p= 0.591, p=0.026 and p=0.606 respectively. Conclusion: Our study results indicate that Non-invasive ventilation (NIV) is effective, reliable, safe and very cost effective method among the patients with respiratory failure due to acute exacerbation of COPD.


2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Federico Lari ◽  
Fabrizio Giostra ◽  
Stefania Guerrini

Treatment of de novo acute hypoxic respiratory failure is not recommended by current Non-Invasive Ventilation (NIV) guidelines as it does not seem to improve patients outcome. Many cases of acute hypoxic respiratory failure associated with Sars-Cov2 infection (SARI) have been observed during Sars-Cov2 pandemic. So far, data are missing regarding the use of NIV, but a correct identification of subgroups of patients based on different clinical, patho-physiological and radiological features, might be helpful for stratifying patients and choosing the correct respiratory support (invasive versus non-invasive). In case of NIV appliance, risk of environmental virus dispersion is particularly elevated; therefore, extreme attention by operators is required.


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