Weaning of mechanically ventilated chronic obstructive pulmonary disease patients by using non-invasive positive pressure ventilation: A prospective study.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) patients frequently pose difficulty in weaning from invasive mechanical ventilation (MV). Prolonged invasive ventilation brings along various complications. Non-invasive positive pressure ventilation (NIPPV) is proposed to be a useful weaning modality in such cases.


OBJECTIVE
To evaluate the usefulness of NIPPV in weaning COPD patients from invasive MV, and compare it with weaning by conventional pressure support ventilation (PSV).


METHODS
For this prospective randomized controlled study, we included 50 COPD patients with type II respiratory failure requiring initial invasive MV. Upon satisfying weaning criteria and failing a t-piece weaning trial, they were randomized into two groups: Group I (25 patients) weaned by NIPPV, and group II (25 patients) weaned by conventional PSV. The groups were similar in terms of disease severity, demographic, clinical and biochemical parameters. They were compared in terms of duration of MV, weaning duration, length of intensive care unit (ICU) stay, occurrence of nosocomial pneumonia and outcome.


RESULTS
Statistically significant difference was found between the two groups in terms of duration of MV, weaning duration, length of ICU stay, occurrence of nosocomial pneumonia and outcome.


CONCLUSIONS
NIPPV appears to be a promising weaning modality for mechanically ventilated COPD patients and should be tried in resource-limited settings especially in developing countries.
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Mayank
M
Mishra
Department of Tuberculosis and Respiratory Diseases, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India.
Sudhir
S
Chaudhri
Consultant Pediatrician (in practice), Rishikesh, Uttarakhand, India.
Vidisha
V
Tripathi
Department of Pulmonary Medicine, King George's Medical University (erstwhile CSM Medical University), Lucknow, Uttar Pradesh, India.
Ajay K
AK
Verma
Consultant Pulmonologist, Miot Hospitals, Manapakkam, Chennai, Tamil Nadu, India.
Arun
A
Sampath
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Nishant K
NK
Chauhan
Chronic obstructive pulmonary disease; invasive mechanical ventilation; non-invasive positive pressure ventilation; weaning