Abstract

It has been reported that non-invasive ventilation is superior to standard medical therapy in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. To compare the effectiveness of non invasive ventilation (NIV) plus standard medical therapy (ST) and ST alone in COPD patients with acute hypercapnic respiratory failure, 20 subjects among patients who were admitted to emergency room were randomized to receive either NIV plus ST or ST alone. NIV was administered with a simple non-invasive ventilator (BiPAP, Resipronics inc., Murraysville, PA, USA) through a full face mask. Expiratory positive airway pressure (EPAP) was 3 cm-H2O in all patients. Initial inspiratory positive airway pressure (IPAP) setting was 8 cm-H2O which was then gradually increased by 1 cm-H2O up to highest tolerable pressure. Mortality rates were 1/10 in NIV group and 3/10 in ST group. Statistically significant differences were observed between baseline and 6th hour measurements for pH and PCO2 in NIV group (pH: 7.23±10, 7.29±9, respectively, p<0.01; and PCO2 : 70.8±11, 65.6±17, respectively, p<0.001). Comparison of the baseline and 6th hour measurements for pH and PCO2 was not statistically significant in ST group (pH: 7.28±6.5, 7.31±7.8, respectively, p>0,05; PCO2 :65.5±8.2, 63±7.2, respectively, p>0.05) Duration of hospitalization in non-invasive ventilation group (9.37±1.8 days) was significantly shorter than that of standard medical therapy group (14.332.64) (p<0.05). We conclude that administration of non-invasive ventilation is more effective than the standard medical therapy in COPD patients with acute hypercapnic respiratory failure.