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

Abstract

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.