Invasive versus Non-invasive Positive Pressure Ventilation In Chronic Obstructive Pulmonary Disease Complicated By Acute Respiratory Failure

Abstract

IntroductionAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is frequently encountered as a medical emergency. AECOPD is the third leading medical cause of hospitalization due to acute respiratory failure (ARF). The utilization of ventilators for patients with ARF secondary to AECOPD has increased. There has been a major inclination towards utilization of non-invasive positive pressure ventilation (NIPPV) and sparing invasive positive pressure ventilation (IPPV) for life-threatening respiratory distress and/or in patients where NIPPV failure is observed. The aim of this observational study was to compare the clinical and laboratory parameters patients with chronic obstructive pulmonary disease (COPD) complicated by ARF admitted in the intensive care unit (ICU).MethodsIn the prospective observational study with known cases of COPD complicated by ARF, patients were grouped into NIPPV and IPPV groups based on their clinical and laboratory parameters. Thirty patients were included in each group. Demographic data was collected. Clinical and laboratory parameters were evaluated at baseline and at 24 hours of ventilation. The outcome was assessed in terms of duration of ventilation, hospital and ICU stay and overall mortality. Data was entered and analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY).ResultsBoth IPPV and NIPPV groups demonstrated marked reduction in partial pressure of carbon dioxide (PaCO2) with 24 hours of ventilation (for IPPV: 78.1 ± 20.2 vs. 69.1 ± 20.2; p=0.08) (for NIPPV: 68.1 ± 17.8 vs. 57.2 ± 21.5; p=0.03). In NIPPV group, there was significant improvement in partial pressure of oxygen (PaO2) (p=0.009), respiratory rate (p=0.008), heart rate (p<0.0001), systolic blood pressure (p=0.03), and diastolic blood pressure (p<0.0001). These parameters did not improve significantly in the IPPV group except for systolic blood pressure (p=0.008). The NIPPV failure rate was 20%. NIPPV patients had a significantly shorter duration of ventilation, ICU stay, and hospital stay. In-ICU mortality was significantly lower in the NIPPV group as compared to IPPV (13% vs. 40%; p=0.01). There was no difference in post-ICU in-hospital mortality between the two groups (6.7% vs. 16.7%; p=0.13).ConclusionBoth NIPPV and IPPV are effective in normalizing acidosis and hypercapnia in patients with COPD complicated by ARF. Patients managed with non-invasive mode of ventilation have a shorter duration of ICU as well as hospital stay. Survival rates are also better as compared to patients managed with invasive ventilation.

Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure Secondary to Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…In comparison to IPPV, NIPPV patients had a significantly shorter duration of ventilation, intensive care unit (ICU) stay, and hospital stay. The failure rate of NIPPV was 20% [9]. In-ICU mortality was significantly lower in the NIPPV group; however, post-ICU in-hospital mortality was comparable between the two groups.…”

“…In a multicenter database study conducted over 15 years (1997-2011), Schnell et al reported that the utilization of NIPPV for patients with ARF needing ventilator support has increased from 29% to 42%; failure of NIPPV remains an independent risk factor for mortality [16]. In acute respiratory failure due to AECOPD or any other etiology, NIPPV has failed as the first-line intervention in as many as 13-53% patients [9,[11][12][13]. And the mortality rate has been higher in patients immediately intubated after NIPPV failure [13,17].…”

“…These outcomes have been measured in terms of reduced mortality rate, need for emergency endotracheal intubation, duration of hospital stay, and rate of complications [2,[6][7][8]. The efficiency of NIPPV therapy in ARF patients secondary to AECOPD has been documented from Pakistan as well [9]. In comparison to IPPV, NIPPV patients had a significantly shorter duration of ventilation, intensive care unit (ICU) stay, and hospital stay.…”

“…Furthermore, patients initially managed on NIPPV may deteriorate and require invasive ventilation during the course of their hospital stay. The rate of NIPPV failure has been reported to be 13-53% in the literature [9,[11][12][13].…”

“…Some studies have compared the clinical and biochemical parameters and outcomes in patients with ARF secondary to AECOPD managed via invasive and noninvasive ventilation [2,7,9,10]. However, few studies have evaluated the patient characteristics and factors leading to the failure of NIPPV in these patients [12].…”