Effect of noninvasive ventilation in chronic obstructive pulmonary disease: hospital outcome

In patients with acute exacerbation of chronic obstructive pulmonary disease, noninvasive ventilation may he used in an attempt to avoid endotracheal intubation and complications associated with mechanical ventilation. We conducted a prospective, randomized study comparing noninvasive ventilation delivered through a facemask with standard treatment in patients admitted to ICU. A total of 23 patients were recruited from a large group of 63 patients with chronic obstructive pulmonary disease admitted to critical care department. A total of 12 patients were randomly assigned to noninvasive ventilation [group I] and II to standard treatment [group II]. The two groups had similar demographic characteristics with mean age 51.8 +/- 10 vs. 58.7 +/- 8.4, p=0.082 and weight 74.8 +/- 13.8 vs. 74.9 +/- 89, p=0.97 and clinical characteristics on admission to the hospital. The use of noninvasive ventilation reduced the need of endotracheal intubation [which was dictated by objective criteria]: 5 of 12 [41.7%] in noninvasive ventilation group were intubated, as compared with 9 of 11[81.8%] [p=0.0487] in standard treatment group. The mean [ +/- SD] treatment duration and hospital stay for patients receiving noninvasive ventilation was significantly shorter than that for patients receiving standard treatment [2.2 +/- 1.2 and 8.8 +/- 9.9 vs. 7.9 +/- 5.2 and 16.2 +/- 5.9, p=0.001 and p=0.004 respectively]. The in-hospital mortality rate was also reduced with noninvasive ventilation I of 12 [8.3%] vs 3 of 11[27.3%], however, did not reach statistical significance [p=0.23 13]. In selected cases with acute exacerbation of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation, the length of the hospital stay and the in-hospital mortality rate

Metabolic profile of critically ill patients

The study was conducted on 31 mechanically ventilated critically ill patients: 11 patients with congestive heart failure [CHF], ten patients with acute respiratory failure, ten patients with sepsis or septic shock, ten volunteers taken as controls. Within one hour of admission, the sedated individuals were subjected to gas mixing chamber indirect calorimetry and the average of 60 readings over one hour was determined. Metabolic profile did not have a consistent pattern in critically ill patients compared with the healthy subjects. However, when divided into various subsets, oxygen consumption was significantly higher in patients with congestive heart failure class III and IV according to NYHA compared with the healthy subjects