Skip to main content
The Egyptian Journal of Bronchology
Download PDF

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

Egyptian Journal of Bronchology volume 11, pages 215–223 (2017)Cite this article

Abstract

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. Delaysin recognizing non responders 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 65years, respiratory rate35ormore,pHless 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.

References

  1. Chakrabarti, Angus RM, Agarwal S, Lane S, Calverley PM. Hyperglycaemia as a predictor of outcome during non-invasive ventilation in decompensated COPD. Thorax 2009; 64:857–862.

    Article  CAS  Google Scholar 

  2. Keenan SP, Slnuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med 2003; 138:861–870.

    Article  Google Scholar 

  3. Lightowler JV, Wedzicha JA, Elliot MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003; 326:185.

    Article  Google Scholar 

  4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of COPD 2014. Available from http://www.goldcopd.org/.

  5. Hill NS, Brennan, Garpestad E, Nava S. Noninvasive ventilation in acute respiratory failure. Crit Care Med 2007; 35:2402–2407.

    Article  Google Scholar 

  6. Plant PK, Elliott MW. Chronic obstructive pulmonary disease • 9: management of ventilatory failure in COPD. Thorax 2003; 58:537–542.

    Article  CAS  Google Scholar 

  7. Carron M, Freo1 U, BaHammam AS, Dellweg D,Guarracino F,Cosentini R, et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth 2013; 110:896–914.

    Article  CAS  Google Scholar 

  8. Wells PS, Anderson DR, Rodger M,Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000; 83:416–420.

    Article  CAS  Google Scholar 

  9. Nava S, Grassi M, Fanfulla F, Domenighetti G, Carlucci, Perren, et al. Noninvasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial. Age Ageing 2011; 40:444–450.

    Article  Google Scholar 

  10. Nicolini, Ferrera L, Santo M, Ferrari-Bravo M, Del Forno M, Sclifo F. Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure. Pol Arch Med Wewn 2014; 124:525–531.

    PubMed  Google Scholar 

  11. Soo Hoo GW, Santiago S, Williams AJ. Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med 1994; 22:1253–1261.

    Article  CAS  Google Scholar 

  12. Iqbal Z, Ziaullah, Basit, Yousaf Khan M, Javaid. Changes in ABGs and respiratory rate before and after NIPPV in AE of COPD. Pak J Chest Med 2008; 14:3–8.

    Google Scholar 

  13. Soliman MA, El-Shazly MI, Soliman YMA, Mostafa AI. Effectiveness of non invasive positive pressure ventilation in chronic obstructive pulmonary disease patients. Egypt J Chest Dis Tuberc 2014; 63:309–312.

    Article  Google Scholar 

  14. Ibrahim BJ, Jaber DK. The effectiveness of non-invasive ventilation in management of respiratory failure in Palestine a prospective observational study. Egypt J Crit Care Med 2014; 2:29–36.

    Article  Google Scholar 

  15. Ahmad H, Ashraf S, Farooqi RJ, Zaman M. Efficacy OF BIPAP in patients admitted with hypercapnic respiratory failure; an experience at a tertiary care hospital. Pak J Chest Med 2014; 20:89–94.

    Google Scholar 

  16. Carrillo, Ferrer M, Gonzalez-Diaz G, Lopez-Martinez, Llamas N, Alcazar M, et al. Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012; 186:1279–1285.

    Article  Google Scholar 

  17. Crummy F, Buchan C, Miller, Toghill, Naughton MT. The use of noninvasive mechanical ventilation in COPD with severe hypercapnic acidosis. Respir Med 2007; 101:53–61.

    Article  Google Scholar 

  18. Cabrini L, Antonelli M, Savoia G, Landriscina M. Non-invasive ventilation outside of the intensive care unit: an Italian survey. Minerva Anesthesiol 2011; 77:313–322.

    CAS  Google Scholar 

  19. Vanani V, Patel M. A study of patients with type II respiratory failure put on non-invasive positive pressure ventilation. Ann Trop Med Public Health 2013; 6:369–377.

    Article  Google Scholar 

  20. Salahuddin N, Irfan M, Khan S, Naeem M, Haque AS, Husain SJ, et al. Variables predictive of outcome in patients with acute hypercapneic respiratory failure treated with noninvasive ventilation. J Pak Med Assoc 2010; 60:13–17.

  21. Moretti M, Cilione C, Tampieri, Fracchia C, Marchioni, Nava S. Incidence and cause of non-invasive mechanical ventilation failure after initial success. Thorax 2000; 55:819–825.

    Article  CAS  Google Scholar 

  22. Dal Negro RW, Bonadiman L, Tognella S, Bricolo F, Turco P. Extent and prevalence of cognitive dysfunction in chronic obstructive pulmonary disease, in chronic non-obstructive bronchitis, and in asymptomatic smokers, compared to normal reference values. Int J Chron Obstruct Pulmon Dis 2014; 9:675–683.

    Article  Google Scholar 

  23. Weinreich UM, Thomsen LP, Bielaska, Jensen VH, Vuust M, Rees SE. The effect of comorbidities on COPD assessment: a pilot study. Int J Chron Obstruct Pulmon Dis 2015; 10:429–438.

    Article  Google Scholar 

  24. Fumagalli G, Fabiani F, Forte S, Napolitano M, Balzano G, Bonini M, et al. INDACO project: COPD and link between comorbidities, lung function and inhalation therapy. Multidiscip Respir Med 2015; 10:4.

    Article  Google Scholar 

  25. Senef MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. J Am Med Assoc 1995; 27:1852–1857.

    Article  Google Scholar 

  26. Pacilli AMG, Valentini I, Carbonara P, Marchetti, Nava S. Determinants of noninvasive ventilation outcomes during an episode of acute hypercapnic respiratory failure in chronic obstructive pulmonary disease: the effects of comorbidities and causes of respiratory failure. Biomed Res Int 2014; 2014:976783.

    Article  Google Scholar 

  27. Nevins ML, Epstein SK. Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest 2001; 119:180–189.

  28. Sundh, Johansson G, Larsson K, Linden, Lofhal CG, Janson C, et al. Comorbidity and health-related quality of life in patients with severe chronic obstructive pulmonary disease attending Swedish secondary care units. Int J Chron Obstruct Pulmon Dis 2015; 10:173–183.

    Article  Google Scholar 

  29. Mannino DM, Thorn D, Swensen, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008; 32:962–969.

    Article  CAS  Google Scholar 

  30. Patel AR, Donaldson GC, Mackay AJ, Wedzicha JA, Hurst JR. The impact of ischemic heart disease on symptoms, health status, and exacerbations in patients with COPD. Chest 2012; 141:851–857.

    Article  CAS  Google Scholar 

  31. Cote C, Zilberberg MD, Mody SH, Dordelly LJ, Celli. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007; 29:923–929.

    Article  CAS  Google Scholar 

  32. Kollert F, Tippelt, Müller C, Jörres RA, Porzelius C, Pfeifer M, Budweiser S. Hemoglobin levels above anemia thresholds are maximally predictive for long-term survival in COPD with chronic respiratory failure. Respir Care 2013; 58:1204–1212.

    Article  Google Scholar 

  33. Song Y, Klevak, Manson JE, Buring JE, Liu S. Asthma, chronic obstructive pulmonary disease, and type 2 diabetes in the Women’s Health Study. Diabetes Res Clin Pract 2010; 90:365–371.

  34. Goodwin JL, Kaemingk KL, Mulvaney SA, Morgan WJ, Quan SF. Clinical screening of school children for polysomnography to detect sleep-disordered breathing – the Tucson Children’s Assessment of Sleep Apnea study (TuCASA). J Clin Sleep Med 2005; 1:247–254.

    Article  Google Scholar 

  35. Krachman S, Minai OA, Scharf SM. Sleep abnormalities and treatment in emphysema. Proc Am Thorac Soc 2008; 5:536–542.

    Article  Google Scholar 

  36. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman, et al. Practice parameters for the indications of polysomnography and related procedures: an update for 2005. Sleep 2005; 28:499–521.

    Article  Google Scholar 

  37. Schettino G, Altobelli N, Kacmarek RM. Noninvasive positive-pressure ventilation in acute respiratory failure outside clinical trials: experience at the Massachusetts General Hospital. Crit Care Med 2008; 36: 441–447.

    Article  Google Scholar 

  38. Bastiansen. Predicting failure of non-invasive ventilation in a mixed population. J Anesth Clin Res 2014; 5:378.

  39. Gill M, Martens K, Lynch EL, Salih, Green SM. Interrater reliability of 3 simplified neurologic scales applied to adults presenting to the emergency department with altered levels of consciousness. Ann Emerg Med 2007; 49:403–407.

    Article  Google Scholar 

  40. Sakr Y, Madl C, Filipescu D,Moreno R, Groeneveld, Artigas, et al. Obesity is associated with increased morbidity but not mortality in critically ill patients. Intensive Care Med 2008; 3:1999–2009.

  41. Mahfouz TA, Hassan K, Abdul-galil D. Early mortality predictors in COPD patients admitted to ICU with severe exacerbation. Egypt J Chest 2005; 54:119–123.

    Google Scholar 

  42. Glossop AJ, Shepherd N, Bryden DC, Mills GH. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis. Br J Anaesth 2012; 109:305–314.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest Diseases, Faculty of Medicine, Minia University, Minia, 61519, Egypt

    Ali O. Abdel Aziz MD, Islam M. Abdel El Bary, Mohammad T. Abdel Fattah & Mohamd A. Magdy

  2. Departments of Clinical Pathology, Faculty of Medicine, Minia University, Minia, Egypt

    Ashraf M. Osman

Authors
  1. Ali O. Abdel Aziz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Islam M. Abdel El Bary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad T. Abdel Fattah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamd A. Magdy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashraf M. Osman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali O. Abdel Aziz MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdel Aziz, A.O., Abdel El Bary, I.M., Abdel Fattah, M.T. et al. Effectiveness and safety of noninvasive positive-pressure ventilation in hypercapnia respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease. Egypt J Bronchol 11, 215–223 (2017). https://doi.org/10.4103/1687-8426.211398

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.211398

Keywords