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

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.

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Correspondence to Ali O. Abdel Aziz MD.

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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

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