Factors leading to poor outcome of noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease

ObjectiveTo determine frequency of factors leading to poor outcome of non-invasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease.MethodsThis cross sectional study was conducted at our center between May 2012 and November 2012. A total of 195 diagnosed patients of acute exacerbation of chronic obstructive pulmonary disease meeting the inclusion criteria were selected from the ER department. At the time of admission age was inquired BP, respiratory rate and oxygen saturation will be noted and pedal edema was assessed and investigations were sent for pH assessment. Noninvasive positive pressure ventilation (NIPPV) using BiPAP was applied in spontaneous mode by the help of oronasal mask. Presence of respiratory rate (less than 12/min), systolic blood pressure <90 mmHg, GCS <13 and PaO2 ≤65, pH <7.2 and heart rate >140 bpm was taken as poor outcome.ResultsThe average age of the cases was 61.9±9.3 years with male to female ratio being 1.5:1. NIPPV was successful in 151 (77.4%) cases and 44 (22.6%) cases were underwent endotracheal intubation. About 38 (44.7%) of patients with oxygen saturation (82%–86%) had poor prognosis. A total of 40 (55.6%) of patients with pH range 7.20–7.26, required endotracheal intubation, 43 (66.2%) with pedal edema underwent endotracheal intubation. While 29 (24.16%) patients of age >60 years needed endotracheal intubation.ConclusionsIn this study, NIPPV was successful in 77.4% cases and 22.6% cases were underwent endotracheal intubation. Pedal edema was the most common factor leading to poor outcomes while age >60 years was the least common factor, 66.2% and 24.2% respectively.