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Category: Volume 06 Issue 06 June 2018
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Title: Predictors of Need for Non-Invasive Mechanical Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Authors: Elham Abdelhady Abdelghany, Rasha Mohammed Emam, Manar Samir Mohamed

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.187

Abstract

Background: COPD remains a common cause of morbidity and mortality worldwide. NIV has been well established as the gold standard therapy for treatment of acute decompensated respiratory failure complicating an acute exacerbation of COPD (AECOPD) with reduced mortality and intubation rates compared to standard therapy. Objective: to evaluate the predictors for the need for NIV in management of AECOPD.

Methods: Eighty adult patients previously diagnosed as COPD presented with AECOPD were assessed with recording of demographic and clinical data, arterial blood gases (ABGs), C-reactive protein (CRP), serum electrolytes (sodium (Na)&potassium (K)) with previously performed spirometry.

Results: The current study showed higher smoking frequency and smoking index in group II patients that were treated with NIV, BMI mean ± SD. was significantly higher in group I who were treated without need for NIV. Group II was presented by more frequent AECOPD, higher heart rate and respiratory rate and longer duration of hospital stay. More cases of group II showed positive CRP (60%) versus 46.7% of group I cases, while mean ± SD of CRP showed insignificant differences between both groups. Serum Na and K were significantly lower in group II. There was significant differences between both groups as regards PH and PaO2/FiO2 as these values were significantly lower in group II patients. Univariate regression analysis elucidated that higher smoking index (SI), PaCO2, and frequent AECOPD were independent positive predictors of the need for NIV in treating cases of AECOPD and higher PaO2 and PaO2/FiO2 were negative predictors of its requirement.

Conclusions: Higher smoking index and frequency, more frequent COPD exacerbations, higher heart rate and respiratory rate,lower serum electrolytes (Na & K),lower PH and PaO2/FiO2 can significantly indicate a more severe AECOPD and higher smoking index (SI), PaCO2, frequent AECOPD, or lower PaO2 and Pao2/FiO2 can be used as independent predictors for the need for NIV.

Keywords: COPD, AECOPD, NIV, ABGs, electrolytes, Na, K

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Corresponding Author

Elham Abdelhady Abdelghany

Chest Department, Faculty of Medicine Minia University