Abstract

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).