Non-invasive mechanical ventilation in respiratory failure due to chronic obstructive pulmonary disease exacerbation

Aim: In the study, we investigated the effectiveness of standart medical therapy (SMT) and SMT with non-invasive mechanical ventilation (NIMV) in patients with hypoxic and hypercapnic respiratory failure due to COPD exacerbation. Material and methods: This study included 66 patients who were diagnosed to have respiratory failure and COPD exacerbation and hospitalized in Ege University Pulmonary Diseases Department Intensive Care Unit. The patients recieving SMT was classified as Group I whereas patients recieving SMT and NIMV as Group II. The two groups were compared regarding blood gases, length of hospital and intensive care unit stay and complications. The effect of NIMV in respiratory failure was prospectively investigated in the patients admitted to intensive care unit due to COPD exacerbation. Results: Among the 66 patients, 28 patients received SMT, 38 of them received SMT with NIMV. On admission, the 'Glasgow Coma Score' was significantly low (p=0.02) and 'Encephalopathy Score' was significantly high (p=0.03) in NIMV patients. The SMT group showed improved PaO2 and pH at every measurement hour and at 6 hours respectively after the treatment, whereas there was no significant difference in PaCO2 values. In NIMV group, there was significantly improvement in pH, PaCO2 and PaO2 values between the initial, 1st, 6 th and 24 th hours measurements (p=0.01). The PaO2 values were significantly higher (p=0.001) in NIMV group than the SMT group in all assessments in the first 24 hours. There was also no significance in hospital and ICU and treatment success for both groups. Only in one patient (3.6%) in SMT group hospital acquired pneumonia developed. The mortality due to respiratory causes in SMT group was higher than the mortality due to other causes in NIMV group (13.2 % versus 7.1% and 7.1% versus % 2.6, respectively). Conclusion: In conclusion, in patients with respiratory failure due to COPD exacerbation although SMT and NIMV help to improve blood gases rapidly, it does not significantly affect the prognosis in hospital.