Pratiksha Moshe Barekar, (2022) Predictors of Outcome of Non-Invasive Ventilation in Patients with Chronic Pulmonary Airway Diseases having Acute Or Acute on Chronic Type 2 Respiratory Failure: A Retrospective study. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: A significant number of patients presenting as emergencies to the respiratory medicine department are patients with acute type 2 respiratory failure with a background of chronic pulmonary disease. As per previous study (Plant et al , Lancet 2000), early use of NIV studied in general ward patients with mild to moderate acidosis ( pH 7.25- 7.35 ), as compared to standard medical management showed significant improvement in terms of reduction in respiratory rate and need for intubation. However, the evidence for benefits of non-invasive ventilation in severe respiratory acidosis is not very strong, and currently most patients with severe acidosis (pH < 7.25), are considered candidates for invasive ventilation without a trial of non-invasive ventilation. However, in more recent studies, the contrary is proven where NIV stands out to be beneficial in acute type 2 respiratory failure despite the severity of acidosis. As per most recent guidelines (ERS/ ATS 2017) a trial of NIV is strongly recommended for all acute/ acute on chronic type 2 respiratory failures even in patients considered to require endotracheal intubation. Noninvasive ventilation reduces the rate of endotracheal intubation and overall mortality in acute respiratory failure and is increasingly applied in respiratory intermediate care units. However, inadequate patient selection and incorrect management of NIV increase mortality. We aim to identify factors that predict the failure of NIV in acute type 2 respiratory failure. AIM OF THE STUDY: To study the Predictors of outcome of Non-Invasive ventilation in patients with Chronic Pulmonary Airway Diseases presenting with acute or acute on chronic type 2 respiratory failure. OBJECTIVES: To understand the factors that may cause increased failure of Noninvasive ventilation treatment in patients with Chronic Pulmonary Airway Diseases presenting with acute or acute on chronic type 2 respiratory failure. METHODS: The study was a retrospective observational cohort study in which, the data of all patients who presented with acute or acute on chronic type 2 respiratory failure over a 5 year period (from April 2015 to March 2020) was collected and analysed. All baseline characteristics and history, examination and relevant investigations were obtained from the online medical records on the clinical workstation and from the in patient files stored in the Medical records Department of Christian Medical College, Vellore. Restoration of pH to normal(>/=7.35) with clinical improvement was considered as a successful outcome. On the other hand, if the patient had required Invasive ventilation or died – it was considered as a failure of NIV. Patients who were discharged against medical advice within 72 hours of treatment without reversal of pH and clinical improvement were also considered as failures. All the data collected was entered into EPIDATA and data analysis was done using STATA/IC 16.0. The variables were compared among those positive and negative for pulmonary embolism using independent t-test and chi-square tests. RESULTS: • We obtained information from records of 268 patients, out of which 76 were excluded as per exclusion criteria. Out of a total of 192 patients, 147 showed a successful outcome with non invasive ventilation. • The prevalence of failure with non-invasive ventilation was found to be 23% and failure rate amongst males (26.5%) was higher than that amongst females (16.6%), however it was not statistically significant. • Age of the patients did not show significant correlation with the outcome. • Significant factors such as history of smoking, exposure to biomass fuel fumes and past history of tuberculosis did not affect the outcome of NIV. • Amongst co-morbidities noted as diabetes, hypertension, ischemic heart disease and congestive cardiac failure, the latter was the only one responsible for a poorer outcome with non-invasive ventilation (60%, P= 0.004). • A higher BMI was significantly associated with more failure (P= 0.01), with the median value amongst failures being 26.7(±3.34 SD). • The results also showed that only 32% of the patients were vaccinated in the past, which however did not significantly affect their outcome after receiving NIV. • The patients who had failed a trial of NIV showed lower serum albumin levels as compared to the ones who showed a successful outcome (P=<0.001). • When the pH in the arterial blood gas was compared amongst the two groups, it showed that amongst the failures, the blood gas after 4 to 8 hrs of therapy showed a pH lower than 7.30 while the success group had shown reversal (pH > 7.30). CONCLUSION: The study has shown that certain factors may cause a higher rate of failure of trial of non invasive ventilation. A higher Body Mass Index, low serum albumin, history of congestive cardiac failure and non-reversal of pH in arterial blood gas within the first 8 hours of therapy are factors that may cause increases chances of failure. In these groups, opting for invasive ventilation may be a better option. Since smokers and those exposed to biomass fumes did not show poorer outcomes with NIV as compared to non smoker, even in people with history of smoking, a trial of NIV is a better option. The higher age of the patients is also not a factor to opt for invasive mechanical ventilation to start with as they also show similar outcomes compared to the younger population.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201927101 |
| Uncontrolled Keywords: | Non-Invasive Ventilation, Patients, Chronic Pulmonary Airway Diseases, Chronic Type 2 Respiratory Failure. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine > MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Jun 2021 00:49 |
| Last Modified: | 03 Mar 2024 16:05 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/17813 |
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