ORIGINAL ARTICLE
Year : 2017  |  Volume : 11  |  Issue : 3  |  Page : 215-223

Effectiveness and safety of noninvasive positive-pressure ventilation in hypercapnia respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease


1 Department of Chest Diseases, Faculty of Medicine, Minia University, Minia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Minia University, Minia, Egypt

Correspondence Address:
Ali O Abdel Aziz
Department of Chest Diseases, Faculty of Medicine, Minia University, Minia, 61519
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-8426.211398

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Background Patients with acute respiratory acidosis caused by an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) constitute the group that benefits most from noninvasive positive-pressure ventilation (NIPPV). However, there are some patients who do not respond to NIPPV. Studies from the west report variable failure rates. Delays in recognizing nonresponders can increase hospital morbidity and mortality. Objective The aim of this study was to assess the effectiveness and safety of NIPPV in patients with acute hypercapnia respiratory failure (AHRF) secondary to AECOPD. Patients and methods This was a prospective observational study of 119 consecutive chronic obstructive pulmonary disease patients who were admitted with a diagnosis of AHRF and in whom NIPPV was applied. Results The overall success rate of NIPPV in the studied group was 94%. Mortality and duration of hospitalization were significantly higher in the failure group (P=0.0001 and 0.002, respectively). The most encountered complications were air leak (29%) and mask discomfort (24%). Comparison between the success and the failure group at the time of hospital admission revealed that the failure group was associated with old age (P=0.043), low hemoglobin (Hb) (P=0.037), low albumin (0.017), lower Glasgow Coma Scale (GCS) score (P=0.0001), higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P=0.001), higher heart rate (P=0.002), lower systolic blood pressure (SBP) (P=0.013), lower diastolic blood pressure (DBP) (P=0.034), and higher white blood cells (WBCs) (P=0.0001). Multiple regression analysis identified age more than 65 years, respiratory rate 35 or more, pH less than 7.26, and WBCs more than or equal to 20 000 or less than 4000 as significant independent predictors of NIPPV failure in our patients. Conclusion NIPPV is an effective and safe modality for treating patients with AHRF secondary to AECOPD. Widespread availability and training of medical staff in the use of NIPPV is recommended.


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