الفهرس 
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Abstract
COPD is now the third leading cause of death in the United States, and its rising mortality trend is unique among the top5 causes of death.
AECOPD are important events in the natural history of COPD, accounting for 1.5 million emergency department (ED) visits and 726,000 hospitalizations each year in the United States.
Over the past 2 decades, NIV has emerged as a potentially useful treatment modality in AECOPD patients with acute respiratory failure. Noninvasive ventilation commonly refers to positive-pressure ventilatory support delivered through a nasal or full-face mask, such as bi-level positive airway pressure. A number of randomized controlled trials and meta-analyses have suggested a mortality-reduction benefit with NIV use compared with standard medical care in AECOPD.
The aim of this study was to evaluate the outcome of patients admitted to RICU with acute exacerbation of COPD and to compare different methods of management.
This prospective study was carried out on 83 patients (57 males and 26 females) who were diagnosed as COPD and admitted to (RICU) with acute exacerbation and acute type II respiratory failure in whom mechanical ventilation was indicated. Noninvasive mechanical ventilation (NIMV) was applied first if patient was in need for mechanical ventilation and had no intubation criteria. NIMV was applied intermittently, for daily periods of at least 4 h. Pressure support with PEEP was the mode of ventilation. The usual setting was 10–15 cm H2O of pressure support and 0–5 cm H2O of PEEP.
The summary of our results:
1. There was no statistical difference between the NIV group and IMV group as regard arterial blood gases (PaCO2, PaO2, SpO2 and HCO3) except PH which was statically higher in NIV group with mean of 7.27±0.05 versus 7.21±0.07 in IMV group (P value <0.0001).
2. There was no statistical difference between the two groups as regard CBC, INR, AST, albumin, total protein, total bilirubin, direct bilirubin, indirect bilirubin, urea and abnormality in urine. ALT and serum creatinine were significantly higher in NIV group compared to IMV group (P value <0.0001). Na and PT were significantly higher in NIV group compared to IMV group (P value = 0.02, 0.01).
3. There was no statistical difference between the two groups as regard cardiac and radiological investigations except pneumonia in chest sonar with 9 (15.25%) patients in NIV group versus 9 (37.50%) in IMV group (P value = 0.03).
4. There was no statistical difference between the two groups as regard clinical condition on admission (previous ICU admission, admission SBP, admission pulse, irregular admission pulse and admission temperature). DBP and RR were significantly higher in NIV group compared to IMV group (P value = 0.01 and 0.03).
5. There was a statistical difference between the two groups as regard duration of ICU stay which was higher in IMV group with mean of 9.92±4.84 days versus 4.69±1.55 days in NIV group (P value = <0.0001), and the need for tracheostomy which was higher in IMV group with 6 (25.00%) patients versus 4 (6.78%) in NIV group (P value = 0.03). Occurrence of complications after weaning were statistically higher in IMV group with 14 (58.33%) patients versus 16 (27.12%) in NIV group (P value = 0.007)
6. As regard arterial blood gases, there was no statistical difference in pH, PaCO2, PaO2 and SpO2 between the survivor group and non-survivor group. HCO3 was significantly higher in survivor group with mean of 31.26±7.19 versus 25.9±7.03 in non-survivor group (P value = 0.005).
7. There was a statistical difference between the two groups as regard Na which was statistically higher in survivor group with mean of 134.68±6.86 versus 128.5±2.96 in non-survivor group (P value = 0.0002), and K which was statistically higher in survivor group with mean of 3.72±0.75 versus 2.82±0.40 in non-survivor group (P value <0.0001).
8. There was a statistically significant difference between the two groups as regard pneumonia in X-ray which was statistically higher in non- survivor group with 6 (30.00%) patients versus 4 (6.35%) patients in survivor group (P value = 0.01), p. embolism (CT) which was statistically higher in non-survivor group with 8 (40.00%) patients versus 10 (15.87%) patients in survivor group (P value = 0.03) and Gold score which was statistically lower in non-survivor group.
9. There was a statistically significant difference between the two groups as regard admission SBP which was statistically higher in survivor group with mean of 119.62±20.75 versus 99.75±17.81 in non-survivor group (P value = 0.0002), admission DBP which was statistically higher in survivor group with mean of 87.86±11.42 versus 59±12.10 in non-survivor group (P value = 0.004) and admission temperature which was statistically higher in non-survivor group with mean of 38.18±0.82 versus 37.45±0.66 in survivor group (P value = 0.0001).
10. There was no statistical difference between the survivor and non- survivor groups according to NIV data (BEEP, FiO2, PS and duration).
11. There was no statistical difference between the survivor and non- survivor groups according to NIV data (IMV Mode either PRVC or SIMV, VT FIO2 RR PEEP and I:E 1:03) except duration which was statistically higher in non-survivor group with mean of 11±7.87 days versus 6.44±2.56 days in survivor group (P value = 0.04)
12. Final logistic regression analysis showed that creatinine, K and pneumonia in x-ray, CT or sonar were significant independent predictors of mortality in AECOPD (P value = 0.005, 0.006 and 0.002 respectively).
13. Final logistic regression analysis showed that Glasgow coma scale, K, pneumonia in x-ray were significant independent predictors of occurrence of complications in AECOPD (P value <0.0001, 0.02 and 0.02 respectively).
14. Final linear regression analysis showed that hypertension admission pulse, admission temperature and IMV VS. NIV were significant independent factors affecting duration of ICU stay in AECOPD (P value = 0.03, 0.04, 0.007 and <0.0001 respectively).
Conclusions
In AECOPD, the weaning was better, and duration of ICU stay, complications after weaning and the need for tracheostomy were lower in NIV group compared to IMV group. However, there were insignificant difference in mortality between NIV and IMV groups.
Creatinine, K and pneumonia in x-ray, CT or sonar were significant independent predictors of mortality in AECOPD.
Glasgow coma scale, K, pneumonia in x-ray were significant independent predictors of occurrence of complications in AECOPD.
Hypertension, admission pulse, admission temperature and IMV VS. NIV were significant independent factors affecting duration of ICU stay in AECOPD.
Recommendations
1. Further clinical research in multi-centers are needed to evaluate the outcome of patients admitted to RICU with acute exacerbation of COPD and to compare different methods of management.
2. Additional studies including a larger number of patients are required for generalization of these results.
3. Long-term follow-up is needed in further studies.