ROLE OF NIV IN ACUTE EXACERBATION OF COPD

Introduction: A globally increasing trend and prevalence with increasing mortality from COPD cases due to acute exacerbation is now a well known and established fact. The infection/ inflammation due to the environmental factors are the trigger for acute exacerbation which leads to dyspnea (SOB) due to hypoxia, hypercapnia or an increase work of breathing and most of these problems get resolved wih BiPAP, a non Invasive ventilator (NIV) devise. It has two level positive pressure delivery setting of air/ oxygen(both for inhalation/ exhalation) via the mask to a orientate patient. However NIV failure or serious cases with comorbidities may require intubation.

Discussion: A primary improvement in arterial blood gases (ABG) and secondary positive changes in SpO2, BP and Pulse and respiratory rate are usually start improving after 2-4 hours of BiPAP application. The overall duration require for the BiPAP failure would depend up the initial status of COPD and accompany comorbidities. The osteoporosis (23%), systemic hypertension (14%), CAD (13%) and heart failure (13%) etc were the main comorbidities observed in our series. An initial starting pressure of 12 and 6 cm of water with step wise 2 cm incremental up to 16-18 cm could be enough to achieve a desired outcomes, without weaning problem. The BiPAP application immediately after the extubation from mechanical ventilator may facilitate or supplement the weaning process without the necessity of reintubation.