Role Of NIV In COPD Exacerbation One Year Experience From A Tertiary Care Hospital

Introduction: Non-invasive ventilation (NIV) refers to delivery of mechanical ventilation with techniques that do not need an invasive endotracheal airway. The main indications are acute exacerbation of COPD, cardiogenic pulmonary edema, pulmonary infiltrates in immunecompromised patients, and weaning of previously intubated stable patients with COPD1. NIV has its best indication in moderate to severe respiratory acidosis in patients with AECOPD. For this indication, studies conducted in intensive care units (ICU's), in wards, and in Accident and Emergency Departments confirmed its effectiveness in preventing endotracheal intubation and reducing mortality 2.Objectives: To see the outcome of NIV in patients of AECOPD with respiratory acidosis. Materials and Methods: The study was conducted in Department Of Emergency Medicine, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J and K, India over a period of one year from October 2015 to September 2016 during which 153 patients of AECOPD were treated with NIV.Results: The study included 153 patients of AECOPD who received NIV, besides standard pharmacologic treatment. 124 (81.04%) patients improved while as 29(18.96%) did not. The patients in the successful group experienced significant improvement in their HR, RR, pH, PaCO2 and PaO2 from 116.2±12.3, 32.4±4.3, 7.27±0.06, 80.7±12.5, and 52.8±10.6 at admission to 102.4±8.3, 26.4±4.4, 7.31±0.07, 70.4±16.4 and 58.6±11.5 , respectively, after 1 hour of NIV. This change in HR, RR, pH, PaCO2 and PaO2 was statistically significant.Conclusion: The study concludes that in patients with AECOPD with moderate- severe respiratory acidosis NIV should be the first line of treatment, besides the standard pharmacologic treatment. JMS 2016; 19(2):59-64