Ефект од неинвазивна позитивно притисочна вентилација кај пациенти со респираторна инсуфициенција како последица на акутна егзацербација на хронична опструктивна белодробна болест

Abstract

Introduction: Non-invasive ventilation (NIV) is conducting mechanical ventilatory support using techniques that do not require endotracheal intubation. Conventional therapy allows continuous oksigen terapy and treatment of causes of exacerbations. Patients who do not response to this treatment are conducted to invasive mechanical ventilation. Endotracheal intubation is associated with high morbidity and mortality, as well as a number of complications. There are not made studies so fare in Macedonia that would assess the success of treatment with NIV. This is the first study in Macedonia for insight into the benefits of treatment with NIV in patients with acute exacerbation of COPD. With this study we will define the place of NIV in the treatment of patients with COPD. The contribution will be great in the subsequent treatment of patients in end-stage COPD. Objective: 1. To determine the effect of NIV in patients with respiratory failure due to acute exacerbation of COPD and whether there is a difference in the outcome of treatment with standard treatment compared with standard treatment and NIV. 2. The hospital mortality in patients treated with NIV compared to patients treated with standard treatment. 3. The duration of hospitalization in patients treated with NIV compared to patients treated with standard treatment. 4. Six-month follow-up study of patients after completion of hospital treatment (number of exacerbations require hospitalization, time of occurrence of first exacerbations, length of exacerbations). 5. To identify indicators that predict the outcome of patients with acute respiratory failure due to COPD. Material and Methods: During the research which will be retrospective-prospective, comparative, open-label, will involve 80 patients aged over 40 years with COPD which will be hospitalized at the Clinic of Pulmonology and Allergology due to severe exacerbation. They will be divided into two groups. The first group of 40 patients will be treated with NIV and standard drug treatment and the second group of 40 patients who will refused treatment with NIV will be treated with standard drug treatment and oxygen therapy. We will note the demographic data and history of the disease, physical findings, body / mass index (BMI), spirometry test, acid base tests, vital signs, X-ray of the lungs, microbiological analysis of sputum. We will determine APACHE II index (acute physiology and chronic health evaluation), filling the questionnaire breathlessness – extended-Medical Research Council Dyspnea (e-MRCD) scale, visual analogue scale (VAS) for measuring the level of dyspnea. Expected results: It is expected to achieve a significant improvement in acid-base status and reducing the need for ETI, reducing the duration of hospitalization and reduced mortality in patients with acute exacerbation of COPD in which NIV is applied, compared with the control group. It is expected the longer time to first exacerbation in the group of patients treated with NIV. It is expected the study to define the indicators during the first 48 hours of treatment wich will have the increased risk of relapse and early prediction of death.