Effectiveness of non-invasive ventilation in patients with type 2 respiratory failure

Shahid M. Patel; Girija P. Nair; Balaji G. Tuppekar; Abhay G. Uppe

doi:10.18203/2320-6012.ijrms20210880

Authors

Shahid M. Patel Department of Pulmonary Medicine, D Y Patil Medical college, Navi Mumbai, Maharashtra, India
Girija P. Nair Department of Pulmonary Medicine, D Y Patil Medical college, Navi Mumbai, Maharashtra, India
Balaji G. Tuppekar Department of Pulmonary Medicine, D Y Patil Medical college, Navi Mumbai, Maharashtra, India
Abhay G. Uppe Department of Pulmonary Medicine, D Y Patil Medical college, Navi Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20210880

Keywords:

Non-invasive ventilation, Acute respiratory failure, ABG, COPD

Abstract

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.

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References

Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al.. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333:817-22.

Honrubia T, García López FJ, Franco N, Mas M, Guevara M, Daguerre M et al. Noninvasive vs conventional mechanical ventilation in acute respiratory failure: a multicenter, randomized controlled trial. Chest. 2005;128(6):3916-24.

Lin MS, Guo HR, Huang MH, Chen CR, Wu CL. Predictors of successful noninvasive ventilation treatment for patients suffering acute respiratory failure. J Chin Med Assoc. 2008;71(8):392-8.

McLaughlin KM. Ward-based non-invasive ventilation for hypercapnic exacerbations of COPD: a ‘real-life’ perspective.

Chang DW. In: Non-Invasive Positive Pressure Ventilation, Clinical Application of Mechanical Ventilation, 3rd edition.194-95.

GumersindoGo´nzalezDı´az. Noninvasive Positive-Pressure Ventilation To Treat Hypercapnic Coma Secondary to Respiratory Failure. CHEST. 2005;127:952-60.

Maheshwari V, Paioli D, Rothaar R, Hill N. Utilization of noninvasive ventilation in acute care hospitals: a regional survey. Chest. 2006;129:1226-233.

Crimi C, Noto A, Esquinas A, Nava S. Non-invasive ventilation (NIV) practices: a European web-survey. Eur Respir J. 2008;32:1970.

Demoule A, Girou E, Richard JC. Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med. 2006;32:1747-55.

Ambrosino N, Vagheggini G. Noninvasive positive pressure ventilation in the acute care setting: where are we? Eur Respir J. 2008;31:874-86.

Ozyilmaz. BMC Pulmonary Medicine. 2014;14:19.

Pingleton SK. Complications associated with mechanical ventilation. In:Tobin MJ (ed) Principles and Practice of Mechanical Ventilation. McGraw-Hill Inc, New York.1994;775-92.

Keenan SP, Sinuff T, Cook DJ, Hill N. When is the addition of noninvasive positive pressure ventilation effective in acute exacerbations of COPD? A systematic review. Ann Intern Med. 2003;138:861-70.

Perrin C, Jullien V, Venissac N. Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Respir Med. 2007;101:1572-78.

Conti V, Paone G, Mollica C, Sebastiani A, Mannocci A, La Torre G, et al. Predictors of outcome for patients with severe respiratory failure requiring non invasive mechanical ventilation. Eur Rev Med Pharmacol Sci. 2015;19(20):3855-60.