Efficacy of NiPPV in Management of Chronic Obstructive Pulmonary Disease in Intensive Care Unit

Abstract

Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. A cardinal symptom of COPD is the chronic and progressive shortness of breath, as most characteristic of the condition. Shortness of breath is often the most distressing symptom, responsible for the associated anxiety and level of disability experienced [28]. COPD is incompletely reversible poor airflow (airflow limitation) and inability to breathe out fully, trapping air. The poor airflow is the result of small airways disease, emphysema, and breakdown of lung tissue. The relative contributions of these two factors vary between people; air trapping precedes lung hyperinflation. COPD currently has no cure, but the symptoms are treatable, and its progression can be delayed by reducing exposure to risk factors, including offering non-pharmacological treatments, such as stopping smoking that will reduce the rate of lung function decline, which in turn reduces mortality. Current treatment involves vaccination, medical treatment, bronchodilators, and antibiotics. In the management of acute hypercapnic respiratory using non-invasive positive pressure ventilation (NiPPV), which is known to be effective in acutely raised levels of carbon dioxide, bi-level positive airway pressure BPAP can decrease mortality and the need for intensive care for end-stage disease; palliative care may be used to support breathing and also reduce daytime breathlessness. There are still great concerns in some patients; it is ineffective and causes delays in moving them to invasive ventilation, and this may worsen the outcomes. Hence, we conducted a retrospective study of 48 COPD patient records. Initially all patients underwent inhalational therapy. Group 1 was 23 and group 2, 25. (36)75% of the total had 3 times inhalational, while the remaining had 2 times only. Group 1 (18) had 78.2% had 3 times inhalational therapy, while group 2 had (15) 69.5% of the patients. Group 1 was treated with NiPPV in PSV or Bi-level mode and increased FiO2; Group 2—with O₂ therapy only. Medical therapy was prescribed regardless of their group allocation. It was seen that the rate of intubation in group one was lesser than that of group 2. Intubation of patients in Group 1: only 6 (26%) that received non-invasive ventilation were intubated as compared to 17 (68%) in Group 2 that were not ventilated. The mortality rate in Group 1 was 21.7% (5 deaths), while in Group 2 the mortality rate was 36.0% (9 deaths). In the analysis of the length of stay in the hospital and ICU, the length of stay in the hospital was statistically near significance; the actual value for group 1 was 20.8±11.3 days, while in group 2 it was 29.1±12.3 days (p=0.063). While looking at the length of stay in ICU, no significant difference was found between the groups: 14.7±12.2 days and 10.8±7 days, respectively (p=0.178). There was evidence in favour of the efficacy of NiPPV in COPD patients with acute exacerbation in terms of mortality and tracheal intubation. No difference in hospital and ICU length of stay was found.