Predictive Factors for the Effect of Treatment by Noninvasive Ventilation in Patients with Respiratory Failure as a Result of Acute Exacerbation of the Chronic Obstructive PulmonaryDisease

Abstract

BACKGROUND: Noninvasive mechanical ventilation (NIV) applies ventilator support through the patient’s upper airway using a mask. AIM: The aim of the study is to define factors that will point out an increased risk of NIV failure in patients with exacerbation of Chronic Obstructive Pulmonary Disease (COPD). PATIENTS AND METHODS: Patients over the age of 40, treated with NIV, were prospectively recruited. After data processing, the patients were divided into two groups: 1) successful NIV treat-ment group; 2) failed NIV treatment group.RESULTS: On admission arterial pH and Glasgow coma scale (GCS) levels were lower (pH: p<0.05, GCS: p<0.05), and Acute Physiology and Chronic Health Evaluation II (APACHE) score and PaCO2were higher (p<0.05) in the NIV failure group. Arterial pH was lower (p<0.05) and PaCO2and respiratory rate were higher (p<0.05) after 1h, and arterial pH was lower (p<0.05) and PaCO2(p<0.05), respiratory and heart rate were higher (p<0.05) after 4h in the NIV failure group.CONCLUSION: Measurement and monitoring of certain parameters may be of value in terms of predicting the effectiveness of NIV treatment.IntroductionChronic Obstructive Pulmonary disease (COPD) is one of the commonest diseases in the world. It is an increasing international health problem with a projected third leading cause of mortality within the adult population[1]. Chronic obstructive pulmo-nary disease is a respiratory disorder largely caused by smoking, and is characterized by progressive, par-tially reversible airway obstruction and lung hyperinfla-tion, systemic manifestations, and increasing fre-quency and severity of exacerbations. An acute exac-erbation is defined as a sustained worsening of dysp-nea, cough or sputum production leading to an in-crease in the use of maintenance medications and/or supplementation with additional medications[2]. The management of the acute exacerbations of COPD accounts for a large proportion of the health care costs because of the need for prolonged hospitaliza-tions and increased rate of mortality[3]. An important event in the course of the disease is the shortening of the inspiratory time, leading to a decrease of the Total Lung Capacity (TLC) and increase of the respiratory rate. The management which aims to increase the TLC with subsequent increase in the alveolar ventila-tion, as well as the decrease of the respiratory rate, is expected to reverse the impaired respiratory physiolo-gy[4].