Non invasive ventilation in COPD.

Non invasive ventilation refers to the technique of providing ventilatory support without a direct conduit to the airway. It is a promising new technique, which is particularly useful in patients with COPD. Patients with COPD are prone to develop acute exacerbations, which pushes them into acute respiratory failure. Under these circumstances, tracheal intubation and mechanical ventilation is associated with significant morbidity and mortality. A number of well conducted studies support the fact that non invasive positive pressure ventilation (NIPPV) in these circumstances reduces rates of intubation, mortality, complications and duration of hospital stay. The biggest advantage of these techniques is their simplicity, ease of implementation and improved patient comfort allowing them to retain important functions like speech, cough and swallowing. NIPPV should be instituted early in the course of acute respiratory failure due to COPD before irreversible fatigue sets in. The current thinking is that NIPPV rests the respiratory muscles allowing other therapies time to be effective. Facilities for NIPPV should be available in all hospitals admitting patients with respiratory failure. Patients with severe, stable COPD who are hypercapnic and are deteriorating despite maximal conventional treatment should definitely be offered a trial of NIPPV. In such patients NIPPV has been shown to improve quality of life, reverse blood gas abnormalities, improve exercise tolerance and reduce hospital admissions. Physicians must familiarize themselves with this promising new ventilatory technique.

A case of recurrent pneumonias.

A description is given of the case of a young boy who presented with repeated episodes of pneumonias since childhood. In addition, he had episodes of intermittent diarrhoeas. His investigative work-up revealed a deficiency of serum immunoglobulins, that is, hypogammaglobulinaemia. The profile was suggestive of common variable immunodeficiency. Because of the relative rarity of this disease, it is often missed leading to significant morbidity. Treatment consists of immunoglobulin replacement therapy and management of recurrent infections with appropriate drugs.

Non invasive ventilation.

Non-invasive ventilation refers to the technique of providing ventilatory support to a patient without an endo/orotracheal airway. It is a promising and rapidly upcoming new technique and is being used as first line therapy in a wide variety of conditions causing respiratory failure. The major indications for its use include respiratory failure due to a variety of causes (chest wall abnormalities, neuromuscular disease, COPD), weaning and stabilization of cardio-respiratory status before and after surgery. Patients who are candidates for this modality usually have a hypercapnic respiratory failure but are able to protect the airway and cooperate with treatment. The biggest advantage of the technique is its simplicity and avoidance of complications of intubation like trauma, infection and delayed complications like tracheal stenosis. Patient comfort is significantly improved and important functions like speech, swallowing and cough are preserved. Several purpose built ventilators are available for use including pressure preset and volume present machines, each of which have their own advantages and disadvantages in clinical practice. A range of patient interfaces is available. The initiation of non-invasive ventilation is much easier as compared to invasive ventilation and can be done for most patients in an intermediary care unit thereby cutting down treatment costs and saving precious intensive care beds. Titration of ventilatory parameters can usually be done using simple tests like oxymetry and blood gases. Several technique related problems like skin pressure sores, nasal symptoms and abdominal distension can be managed with simple measures. Non invasive ventilation has got a special and evolving role in management of COPD, both in acute exacerbations and chronic respiratory failure. In short, the advantages of this form of ventilation are numerous and physicians must familiarize themselves with this new technique, facilities for which should be available in all hospitals admitting patients with respiratory failure.