Non-invasive ventilation (NIV) is being used more frequently in the management of acute exacerbations of chronic obstructive pulmonary disease (COPD ). We hereby present our experience at a university hospital setting in Turkey.
Twenty-two patients with a COPD exacerbation whom were treated with NIV in the first place were enrolled in the study. Of 22 patients(82% males, mean age of 63.4), eight (36%) had a mild, 10(46%) had a moderate and four(18%) had a severe exacerbation. Comorbidities were present in 82% of them, and 68% had previous hospitalizations for exacerbation. APACHE II score (mean+/-SD) was 18.09+/-4.02.
NIV was initiated in the emergency department in 9% of patients, in an ICU setting in 77%, on a general ward in 14% . The mean baseline pH, pO2 and pCO2 at baseline were 7.39(9% with a pH of < 7.30), 57+/-17 mmHg(63%with pO2<60mmHg),and 56+/-14 mmHg (87% with pCO2>45mmHg) respectively. Mean duration of NIV and total length of hospital stay were 9 and 18 days respectively. On follow-up, two patients (9%) required endotracheal intubation (ETI), and there was only one death (4.5%). Success of NIV was not correlated with APACHE score, age, severity of exacerbation, number of previous hospitalizations, pCO2 and pH, although one failed patient had a pH<7.30. Baseline pO2 (k=-0.470, p=0.027) and spO2 ( k=-0.491, p=0.020) were found as negative predictors of NIV success. On discharge, home ventilators were prescribed to three(13,5%) patients.
We have found that NIV was iniatiated and used mostly inside of a critical care setting in our institution. Our outcomes of ETI and death were lower than those reported previously because less severe exacerbations were present in our series. Hypoxemia was found as the main predictor of NIV success.
NIV should be considered early in the course of acute exacerbations of COPD and before severe hypoxemia ensues, in order to reduce the likelihood of ETI, treatment failure and mortality.
Meltem Tor, None.