Early use of noninvasive techniques for clearing respiratory secretions in COPD

A novel technique involving NPPV reduced the risks of nosocomial infection, requirement for intubation, and hospital mortality in patients with COPD.
A novel technique involving NPPV reduced the risks of nosocomial infection, requirement for intubation, and hospital mortality in patients with COPD.

Noninvasive positive-pressure ventilation (NPPV) combined with a noninvasive strategy to clear secretions during the first 2 hours may be more beneficial than conventional mechanical ventilation (CMV) for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and hypercapnic encephalopathy, according to a study published in Medicine.

Jinrong Wang, MD, from Southern Medical University, Guangdong, China, and colleagues conducted a prospective cohort study of patients with acute exacerbations of COPD and hypercapnic encephalopathy who were enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital.

A total of 74 patients received NPPV, and 90 patients received CMV. Inclusion criteria included physician-diagnosed acute exacerbations of COPD, spontaneous airway clearance of excessive secretions, arterial blood gas analysis requiring intensive care, moderate-to-severe dyspnea, and a Kelly-Matthay Scale score of 3 to 5.

ICU patients were managed with use of NPPV, and participants received standard treatment consisting of controlled oxygen therapy during NPPV-free periods; antibiotics, IV doxofylline, corticosteroids (salbutamol and ambroxol), and subcutaneous low-molecular-weight heparin; and therapy for comorbidities if necessary. Nasogastric tubes were inserted in participants who developed gastric distension. Pharmacologic sedation was not used. Primary and secondary outcome measures included comparative complication rates, duration of ventilation and hospitalization, number of invasive devices per patient, and in-hospital and 1-year mortality rates

According to the researchers, arterial blood gases and sensorium levels improved significantly within 2 hours among patients in the NPPV group, with lower hospital mortality, fewer complications and invasive devices per patient, and superior weaning off of mechanical ventilation. Mechanical ventilation duration, hospital stay, and 1-year mortality were similar between the 2 groups.

“The use of an oropharyngeal airway and suction aspiration, in combination with appropriate positioning of the patient and nebulized inhalation of salbutamol/ambroxol, was a feasible, simple, safe, and effective method for clearing respiratory secretions during the first 2 hours of NPPV in patients in the ICU with acute exacerbations of COPD and hypercapnic encephalopathy,” stated the study authors.

“Moreover, compared with CMV, this innovative strategy reduced the risks of nosocomial infection, requirement for intubation, and hospital mortality, and showed superior results in terms of weaning from ventilation. Therefore, we propose that this novel NPPV strategy might be a successful alternative to CMV in selected patients with acute exacerbations of COPD in the ICU, where there is prompt access to endotracheal intubation if needed.”

References

  1. Wang J, Cui Z, Liu S, et al. Early use of noninvasive techniques for clearing respiratory secretions during noninvasive positive-pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic encephalopathy: A prospective cohort study. Medicine (Baltimore). 2017;96(12):e6371.
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