Noninvasive ventilation and inhalational nebulized therapy in the intensive care of acute exacerbation of chronic obstructive pulmonary disease

The aim of the study was to increase the efficacy of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) using concomitant noninvasive ventilation (NIV) and inhalational nebulized therapy (INT). Methods. Patients with COPD were treated with concomitant NIV and INT (n = 50) or with NIV followed by INT after weaning the patients from ventilator (n = 49). Duration of the patient’s stay in the intensive care unit (ICU) was used to assess the efficacy of the treatment. The two therapeutic approaches were compared using blood gas analysis (partial pressure of oxygen (PO2) and carbon dioxide (PCO2) in the arterial blood and pulse oximetry. The target blood gas value indicating the efficacy of the therapy was pO2 > 60 mm Hg. Results. In 1 hour of the treatment, this outcome measure was achieved in 86% (n = 43) and in 59% (n = 29) of patients in the groups of concomitant vs consequent NIV + INT treatment, respectively (χ2 = 8.98; p = 0.0027). PO2 differed insignificantly in both groups and was < 45 mm Hg in 31 (62%) and 36 (73%) of patients, respectively (χ2 = 1.49 p = 0.22225), after 1 hour if the treatment. Pulse oximetry did not change in patients with the increase in PO2; this could be due to a low informative value of SaO2 during the intensive care of AECOPD. Conclusion. The concomitant use of NIV + INT in patients with AECOPD allowed 1.5-fold improvement in blood gas parameters during the first hour of the treatment. This could improve the treatment efficacy, avoid the need in invasive ventilation, and shorten the patient’s stay in ICU. Therefore, the blood gas parameters are more preferable for the choice of the type of respiratory support compared to the pulse oximetry in patients with AECOPD.

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