Prospective Comparative Evaluation of Noninvasive and Invasive Mechanical Ventilation in Patients of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure Type II

Abstract

Introduction: Acute respiratory failure is a potential complication of chronic obstructive pulmonary disease (COPD) that severely affects the health of the patient and may require mechanical ventilation. We compared noninvasive and invasive mechanical ventilation in COPD patients with acute respiratory failure type II to validate clinical outcome based on biochemical analysis of arterial blood gases (ABGs) and pulmonary parameters in terms of duration of mechanical ventilation, period spent in intensive care unit (ICU) and mortality. Materials and Methods: After approval of institutional ethical committee 100 patients were selected for randomized prospective controlled trial and divided into two groups of 50 each according to mode of mechanical ventilation. Group-I patients managed with noninvasive ventilation (NIV) Group-ll managed with invasive ventilation. Results: Demographic data between two groups were comparable. ABG parameters were better at 2 h and 6 h interval in NIV as compared to invasive ventilation ( P < 0.05). The duration of ventilation and total time spent in ICU was 106±10 hours and 168±8 hours respectively in NIV group and 218 ± 12 and 280 ± 20 in invasive group. On intergroup comparison these were significantly less in noninvasive group ( P < 0.05). Hospital acquired pneumonia occurred in 10% of patients in invasive group whereas no incidence of pneumonia found in noninvasive group. Mortality rate was 12% in invasive groups and 2% in noninvasive groups. Conclusion: NIV leads to significant improvement in ABG and pulmonary parameters and it reduces duration of ventilation and total period of hospital stay so it can be used as an alternative to invasive ventilation as first-line treatment in COPD.

The Indications of Tracheostomy in Basrah (Iraq): A Retrospective Descriptive Study

“…Therefore, tracheostomy is generally considered an elective procedure, with the exception of a fewer cases in which endotracheal intubation cannot be done initially [12][13][14]. Indications for tracheostomy can be broadly categorized into three major groups namely: (i) to relieve an upper airway obstruction [15,16], (ii) to assist ventilation [17][18][19] and (iii) to facilitate toilet of both trachea and bronchus [20,21].…”