Comparison of Invasive vs Noninvasive mechanical Ventilation in Acute Exacerbation of COPD Patient for Ease of Ventilation Weaning & Outcome.

Background: Acute exacerbation of the COPD can cause respiratory failure which requires ICU and mechanical ventilation. But invasive mode of ventilation associated with various complications, weaning failure, lengthy hospital stay and more mortality and morbidity. So our aim in the study was to compare it with the noninvasive mode and their outcome. Methods: A prospective randomized non blind study was undertaken in 104 patients of either sex, age group 35 to 65 with acute exacerbation of COPD. Patients were randomized in to either group odd or even number basis, one group received Non Invasive Ventilation (NIV) and other group received Invasive Mechanical Ventilation (IMV).Ease of ventilation was studied by serial estimation of tidal volume (TV), respiratory rate (RR), pressure support needed (PC above PEEP), PaCO2, Ph at 0 , 4th ,12th, 24th , 48th hr of Mechanical ventilation and at the beginning of weaning .Ease of weaning was studied in terms of time needed for weaning, Number of weaning trials attempted, Percentage of weaning failure, Complications faced. Results: The mean tidal volume requirement was more in NIV group when compared to IMV group. Mean of Respiratory rate at the time of admission in NIV group was high, and there was gradual reduction in respiratory rate over time. At the time of admission mean PaCO2, PaO2, Ph were not statistically significant in both the groups but with time the improvement in PaCO2 was better in IMV group when compared to NIV group (p value < 0.001) and the correction of ph was rapid in IMV group when compared with NIV group.(p value <0.001). Patients on IMV needed more time for weaning when compared to NIV group. More number of weaning attempts were required in IMV group. Conclusion: IMV was a better mode for maintenance and NIV was better for weaning and overall outcome of ventilation of COPD patient. So NIV may be preferred as mode of choice unless there is chance of complication due to it.

A Comparative Study of the Effects of Intrathecal Tramadol and Intrathecal Fentanyl as Adjuvants with 0.5% Bupivacaine Heavy in Lower Limb Surgery.

Background: The aim of this study is to compare the effects of tramadol and Fentanyl as intrathecal adjuvant to hyperbaric Bupivacaine in lower limb surgeries under spinal anaesthesia. Methods: 100 patients of ASA status I and II posted for lower limb surgery were randomly divided into two groups. Group T was administered Hyperbaric Bupivacaine 15 mg + tramadol 25 mg, group F was administered Hyperbaric Bupivacaine 15 mg + Fentanyl 25 μg. Hemodynamic parameters, duration and quality of sensory and motor block and any side effects were assessed. Results: Intrathecal tramadol and intrathecal fentanyl acted synergistically to potentiate bupivacaine induced sensory spinal block. Excellent surgical anaesthesia and an extended analgesia were observed in the post-operative period with minimum side effects in both groups. Conclusion: Addition of either intrathecal tramadol or fentanyl to bupivacaine produced comparable hemodynamic changes, post-operative analgesia and sensory blockade.