Online ISSN: 2515-8260

Keywords : AECOPD

A Hospital Based Prospective Study to Assess the Effectiveness of S/T Mode BIPAP and AVAPS Mode by Applying the Clinical and ABG Parameters at Admission and After 3 Hours and 6 Hours of Applying Non- Invasive Ventilation (NIV) in Management of Type-2 Respiratory Failure in AECOPD Patients in the Emergency Department/ICU

Suman, V.B. Singh, Deepak Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2261-2267

Background: Noninvasive ventilation (NIV) refers to the delivery of ventilatory support or positive pressure into the lungs without an invasive endotracheal airway, usually through a mask.The aim of this study to assess the effectiveness of S/T mode BIPAP and AVAPS mode by applying the clinical and ABG parameters at admission and after 3 hours and 6 hours of applying non- invasive ventilation (NIV) in management of type-2 respiratory failure in AECOPD patients in the emergency department/ICU.
Materials& Methods: A hospital based prospective study done on 50 patients with acute respiratory distress in ICU at SMS Medical College, Jaipur, Rajasthan, India during one year period. Patients were entered into the study if they were aged>18 yrs and had evidence of ARF as demonstrated by three of the following criteria: acute onset of moderate-to-severe dyspnoea as assessed by the ED physician who took care of the patient; a respiratory rate>30 (or<10) breaths/ min.; hypoxaemia (oxygen tension in arterial blood (Pa,O2) <7.3 kPa (55 mmHg) (on room air)) or need for O2 supplementation; respiratory acidosis (pH<7.33). 25 patients with acute exacerbations of COPD with GCS < 10 were designated to receive BiPAP S/T and 25 patients with acute exacerbations of COPD with GCS < 10 were designated to receive with AVAPS.Each patient was treated with NIV and was selected according to: APACHE II score within 4 points, age within 10 points, pH within 0.04, GCS within 2 points, and BMI within 2 points.
Results: The mean age of all patients was 78.72±11.43 years, mean APACHEII score was 18.47±2.55. There were no statistically significant differences between the two groups in terms of BMI, age, APACHEII score, or initial GCS score.The ANOVA analysis revealed statistically significant differences in favor of AVAPS for pCO2 (P <0.05*), respiratory rate (P<0.05*), maximum IPAP (P <0.05*), GCS score (P <0.001*) and ETV (P <0.05*). However,no significant differences were observed for length of stay (P >0.05) ordurationofNIV(P>0.05).

The Bacteriological profile and antibiotic sensitivity Pattern in AECOPD Patients

Dr.Aarif Khan, Dr.MazherMaqusood, Dr.Sudhir Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5082-5090

Aim: In light of the paucity of data on the bacteriological layout of AECOPD sufferer in
our country, the current study examined the layout of sputum bacteria and antibiotic
sensitivity in AECOPD hospitalized patients.
Material and methods: It was a prospective observational study conducted among 45
AECOPD patients diagnosed according to GOLD guideline (2019) in the department of
pulmonary medicine, TMMC & RC, Moradabad. Sputum sample was collected in the
morning before any meal & patient should not use oral antiseptics. After inoculating the
sample for 48 hours, inoculation culture plate with growth was identified on the basis of
culture characteristics, gram staining and biochemical reaction according to standard
guidelines.The antibiotic sensitivity of recovered isolates were determined by Kirby
Bauer disc diffusion method.
Results: The findings revealed that pseudomonas aeruginosa (42.2%) was the most
common isolated organism.It was sensitive to Cefepime (except one case),
Cefoperazone+Sulbactum, Ceftazidime (except one case), Meropenam (except two
cases), Colistin and Piperacillin+Tazobactum but resistant to Tigecycline and
Levofloxacin.Enterococcus species were sensitive and resistant to Linezolid and
Levofloxacin respectively. All the Escherichia coli cases were sensitive to Cefepime,
Cefoperazone+Sulbactum (except one case), Meropenam, Tigecycline, Colistin,
Piperacillin+Tazobactum but resistant to Ceftazidime and Levofloxacin.
Staphylococcus aureus were resistant to Levofloxacin and Linezolid.Staphylococcus
aureus (MRSA) was resistant to Levofloxacin and sensitive to Linezolid, Clindamycin
and Vancomycin.
Conclusion:Antibiotics must be prescribed depending on the bacterium susceptibility
profile found in the area. Prescribed patients with history for production of purulent
sputum is worth following the guidelines or protocol. It is high time to have a policy for
antibiotics usage at different levels- district, state and country to prevent the emergence
of MDR strains.