ABSTRACT
In patients with COPD and mild to moderate hypercapnic ARF, the addition of NPPV to medical treatment has been proven to be effective in relieving dyspnea, improving vital signs and gas exchange, preventing endotracheal intubation and improving hospital survival. For this reason we compared the response to conventional ventilation delivered via ETI vs. NPPV delivered via face mask in COPD patients with ARF failing to sustain the initial improvement with conventional medical therapy in the emergency ward and meeting predetermined criteria for mechanical ventilation. We evaluated 72 consecutive patients. 18 were already intubated and 14 improved with standard medical therapy. The condition of 40 patients initially improved with medical therapy, and they stayed in the medical ward, but their improvement was not maintained over time and<24h. They met predetermined criteria for ventilatory support and were admitted to receive mechanical ventilation. 18 patients were randomized to NPPV and 22 patients to [ETMV] conventional ventilation. There were no differences between the two group before institution of mechanical ventilation, except in SAPS II, Albumin and GCS were significantly different [0.006, 0.05, 0.003] respectively. Patients randomized to NPPV, had a trend toward a lower rate of ventilator associated pneumonia [2vs.7] severe sepsis [lvs.7] and septic shock [lvs.3]. NPPV had decreased duration of ventilation, ICU stay, and post ICU hospital stay. [12.5vs.7.8 and 13.2 vs. 8.83 and 7.27vs.4.5] respectively [SD]. The ETMV group had a trend toward requiring permanent oxygen supplementation and open tracheastomy in comparison with NPPV group [8vs.0 and 5vs.2] respectively [%]. After failure of medical treatment in acute exacerbation of COPD patients NPPV is comparable to invasive mechanical ventilation. The reasons for improved outcome are not clear, but it is possible that a reduction in duration of ventilation, ICU stay, mortality rate and serious complications may play an important role, Improvement in PH and a decrease in PCO[2] after 2h of use benefited from NPPV. There are no clear clinical predictors to identify which patients with COPD RF would benefit from NPPV. A score based on SAPS II and serum albumin level is predictive of outcome in COPD patients. A high percentage of patients with the primary diagnosis of COPD successfully treated with NPPV