Vnitr Lek 2006, 52(3):241-248

Non-invasive ventilation support in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD)

P. Matuška^*, O. Pilařová, Z. Merta, J. Skřičková

Klinika nemocí plicních a TBC Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednostka doc. MUDr. Jana Skřičková, CSc.

Aim:
To verify that the use of noninvasive ventilatory support in acute exacerbation of chronic obstructive pulmonary disease leads to decreasing the number of deaths, shortening in-hospital stay and decreasing number of endotracheal intubations (ETI).


Setting:
The study was conducted at a respiratory department's ICU in 2002-2004.

Methods:
Patients hospitalized on ICU with acute exacerbation of COPD, respiratory acidosis and global respiratory failure were randomised into two groups. Patients in group A were treated by conservative medical therapy (oxygen, bronchodilator, corticosteroid), patients in group B received noninvasive ventilation with face mask. The parameters followed were: decrease in the number of deaths, shortening of ICU stay, reduction of ETI, faster improvement of breathing frequency, heart rate, pH, PaO₂, PaCO₂, lactate, dyspnoea symptom score and lung functions.

Results:
Each group consisted of 30 randomised patients. There were 10 intubated patients in group A, as opposed to 3 in group B (N = 60; P = 0.034). Average length of ICU stay was 9.8 days in group A and 7.1 days in group B (N = 60; P = 0.756). Mortality rate was identical in both groups: 3 patients survived, 7 patients died. We found faster decrease of breathing frequency after one hour of noninvasive ventilation in group B (28.3 ± 7.1 vs. 24.6 ± 6.3, N = 59, p = 0.03).

Conclusion:
No difference was found in mortality rate. We observed decreasing of ETI rate with NIV. We found a tendency to shortening of ICU stay. There was faster improvement of breathing frequency after one hour of NIV.

Keywords: noninvasive ventilation; chronic obstructive pulmonary disease; respiratory failure

Received: October 21, 2005; Accepted: January 2, 2006; Published: March 1, 2006  Show citation