Non-invasive ventilation: BIPAP

NIV is an effective treatment strategy for patients admitted to hospital for acute exacerbations of COPD and respiratory failure. [Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD004104. DOI: 10.1002/14651858.CD004104.pub4] But it needs some consideration like patients ability to maintain airway, consciousness, pH level, secretion amount etc. Although comatose patient (due to CO2 retention / narcosis) with good respiratory trigger is also advocated for NIV as initial trial, it should be noted that NIV should not an alternative when there is clear indication of intubation and ventilation. Usually COPD patients with pH 7.35 – 7.25 are tried with NIV.

One must be selective in the post-surgical population with COPD. Although the morbidity and mortality is increased when a surgical patient is re-intubated, a thoughtful assessment of pathophysiology must be made. Residual muscle weakness associated with neuromuscular blockers, narcosis or residual anesthetic gases will exasperate COPD symptoms and may be best resolved with a short course of mechanical ventilation. I have had anecdotal experience of patients receiving NIV when tracheal intubation would have prevented significant gastric distention.

Regards,

Christopher

CPAP

The overall physical status of the patient including premorbid state,and current status must be taken into account when planning any intervention in cases of severe COPD.

Also,(and this is often overlooked),the treatment plan should be discussed with the patient and family as many simply may not wish for the full consequences of mechanical ventilation and prolonged weaning etc etc.

We routinely discuss plans with our patients,and make sure they are aware of the problems in as many presenting cases as possible.

When the need for asssisted entilation comes,we would prefer to start with non-invasive tecniques such as CPAP or BIPAP before proceeding to IPPV wherever possible although a number of patients do present in extremis.

The most effective treatament for respiratory failure in acute COPD exacerbations is mechanical ventilation.

However bi-level ventilation has a solid evidence base for mild respiratory acidaemia (pH >7.25) and reasonably could be trialed in an appropriate setting.

CPAP would only be indicated in isolated hypoxaemia which is not usually seen in COPD exacerbations.

Check the following reference Please.. it might's assist you in your question …

https://www.nice.org.uk/guidance/gid-ng10115/documents/draft-guideline-2

If you make a diagnosis and initiate specific treatment for that diagnosis but the patient does not improve it is important to consider alternative diagnoses. For example cardiac failure, pneumothorax or pulmonary embolism.

The answer would be a trial of non-invasive ventilation, provided there are no contra-indications for NIV ( altered sensorium, unable to cough out, etc)

Acute exacerbation of COPD case the patient are advised to hospitalised for proper medical management with oxygen supplement and dirps later on some homoeopathy drug are to be given for curative treatment as tuber culinium, blatta orientale sulphur

Start with niv if there is no contraindications like comatose patient,ph range 7.30 monitor sequenctially ,if patient worsens then go for mechanical ventilation