Dr Sucheta Meshram Bhowat


Acute respiratory insufficiency due to chronic obstructive pulmonary disease (COPD) presents an enormously
increasing problem in health sector[1] The choice of treatment of chronic respiratory failure in COPD patients depends
primarily on which part of the respiratory system is impaired. pulmonary failure with the hallmark of hypoxaemia is a well-justified . In contrast,
respiratory failure coupled with reduced alveolar ventilation requires artificial augmentation of alveolar ventilation.. Mechanical ventilation is
often applied in the late stages of COPD or in patients with rapid clinical deterioration [3] . Applying the standard invasive mechanical ventilation
(IMV) means confronting the patient with all the side effects and complications following endotracheal intubation [3]
These complications include: damage to the trachea caused by endotracheal tube producing ulceration, oedema and haemorrhage that can lead
to tracheal stenosis [4]. There are also potential complications of this MV method eg damage to the face and nose skin, gastric distension with
aspiration risk, sleeping disorders and conjuctivitis [5] Noninvasive mechanical ventilation (NIMV) presents an alternative to conventional IMV
through an endotracheal tube, both in early stage of ARF as well as in patients with severe diseases[6,7]. It includes similar techniques for
alveolar ventilation improvement to those of IMV, but without endotracheal intubation[8]
It permits a higher inspired oxygen content than other methods of oxygen supplementation, increases mean airway pressure, and will improve
ventilation to collapsed areas of the lung. The recruitment of underventilated lung is similar to the use of positive end expiratory pressure (PEEP)
in the intubated mechanically ventilated patient. It also unloads the inspiratory muscles and thereby reduces inspiratory work, although in
hyperinflated patients with airflow obstruction any further increase in lung volume produced by it may have an adverse effect on the function of
the inspiratory muscles. In cases of respiratory failure due to exacerbations of COPD, the offsetting of intrinsic PEEP may reduce ventilatory
work resulting in a slowing of respiratory rate, an increase in alveolar ventilation, and a fall in PaCO2.Hence a retrospective analysis was done to
study the efficacy of NIV in acute exacerrrbation of COPD patients .
MATERIAL AND METHODS: A retrospective analysis was done to ascertain the effect of early NIV on the respiratory improvement of
patient in acute respiratory insufficiency .As per the guidelines laid down by the thorasic society[2002 GUIDELINES ]] and as per the
institutional protocol NIV was used as a therapeutic modality..The effect was stastistically analysed .40 patients of COPD were studied
retrospectively.Out of them Group A comprises of 20 patients who were ventilated with NIV (Bipap) and othe Group B comprises of 20 patients
who were not been given appropriate NIV for required stipulated time due to various factors .Although group B candidates fulfill the criteria for
NIV but the patients were either extremely uncooperative , highly apprehensive about the NIV system ,unable to purchase appropriate sized
mask .This caused inappropriate use of NIV in proper stipulated time required in group B patients
Observations: It was observed that there was significant improvement in respiratory parameters when NIV was used early .Minute ventilation
as well as respiratory acisosis improved significantly .Moreover patient was able to take calories orally,was able to sleep n could interact with the
health care providers. Need of invasive ventilation was prevented and thereby its complications .Since initial improvement encourages the
patients for further cooperation and creates vicious cycle of positive events.
Conclusion: NIV proves to be an effective modality for acute respiratory insufficiency in COPD patients.Its recommended to start NIV support
early to obtain better clinical outcome.

Full Text:



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