What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

Abstract

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

<p>High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: an observational cohort study</p>

“…COPD was diagnosed on the basis of the clinical history, physical examination, chest radiograph and available lung function tests. General indications for NIV or HFNC when treating COPD in our uint include respiratory acidosis (pH ≤7.35 and PaCO 2 ≥50 mmHg), an exacerbation of dyspnea with evidence of accessary respiratory muscle use, and persistent hypoxemia despite oxygen therapy 14. Among those COPD patients who were treated with HFNC (Optiflow TM , Fisher&Paykel Healthcare) or NIV (BiPap Vision or PHILIPS V60) within four hours of admission, patiens meeting criteria for moderate hypercapnic ARF were included.…”

Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis

“…Chronic hypercapnia respiratory acidosis is a common feature of acute exacerbation of COPD, which is called acute hypercapnia respiratory failure (AHRF) [ 3 ]. At this time, severe ventilation dysfunction occurs in the patient, and the probability of disability and death is very high if the patient does not receive timely and effective treatment [ 4 ]. Clinically, emergency endotracheal intubation assisted by an invasive ventilator can significantly improve the respiratory status of patients, but there are still some cases after extubation, such as incomplete control of pulmonary infection, weak muscle strength, poor expectoration ability, and mild respiratory failure, which require postextubation treatment.…”

Effects of high-flow nasal cannula oxygen therapy for patients with acute exacerbation of chronic obstructive pulmonary disease in combination with type II respiratory failure

“…17 In addition, compared with NIPPV, HFNC can improve the comfort of patients by making it easier for them to drink, eat, remove sputum, and communicate; and it is also not associated with pain around the nose, which is caused by tight masks and fixed headbands. [18][19] We evaluated the comfort of the participants before and after treatment by assessing their pulmonary function and dyspnoea, using a questionnaire regarding CA, DA and EA. After treatment, the CA and EA scores of the HFNC group had decreased significantly and to a greater extent than those of the control NIPPV group.…”

“…The reporting of this study conforms to the CONSORT guidelines. 11 Statistical methods SPSS v. 19.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis.…”