Early Effectiveness of Noninvasive Positive Pressure Ventilation on Right Ventricular Function in Chronic Obstructive Pulmonary Disease Subjects with Acute Hypercapnic Respiratory Failure

Document Type : Original Article

Authors

1 Pulmonologist, Lung Disease research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Cardiologist, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Fellow of Hematology and Oncology, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Emergency Medicine, Lung Disease Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP
(NT-proBNP), and ventilatory parameters in the COPD patients with AHRF.
Materials & Methods: This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV.
Results: According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO2, PAP, and NT-proBNP (P<0.001, P=0.003, P<0.001, and P<0.001, respectively).
Conclusion: As the findings of the present study indicated, the application of NIPPV in the COPD patients with AHRF can not only improve arterial blood pH and carbon dioxide tension, but also instantly decrease
NT-proBNP levels and PAP.

Keywords

References

  1. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003; 326:185.
  2. Agarwal R, Gupta R, Aggarwal AN, Gupta D. Noninvasive positive pressure ventilation in acute respiratory failure due to COPD vs other causes: effectiveness and predictors of failure in a respiratory ICU in North India. Int J Chron Obstruct Pulmon Dis. 2008; 3:737-43.
  3. Brochard L, Mancebo J, Elliott MW. Noninvasive ventilation for acute respiratory failure. Eur Respir J. 2002; 19:712-21.
  4. Roberts JR, Hedges JR. Roberts and Hedges’ clinical procedures in emergency medicine. 6th ed. New York: Elsevier Health Sciences; 2014.
  5. Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000; 355:1931-5.
  6. Januzzi JL Jr, Camargo CA, Anwaruddin S, Baggish AL, Chen AA, Krauser DG, et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol. 2005; 95:948-54.
  7. Costello-Boerrigter LC, Boerrigter G, Redfield MM, Rodeheffer RJ, Urban LH, Mahoney DW, et al. Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: determinants and detection of left ventricular dysfunction. J Am Coll Cardiol. 2006; 47:345-53.
  8. Phua J, Lim TK, Lee KH. B-type natriuretic peptide: issues for the intensivist and pulmonologist. Crit Care Med. 2005; 33:2094-13.
  9. Leuchte HH, Baumgartner RA, Nounou ME, Vogeser M, Neurohr C, Trautnitz M, et al. Brain natriuretic peptide is a prognostic parameter in chronic lung disease. Am J Respir Crit Care Med. 2006; 173:744-50.
  10.  Flenley D. Long-term domiciliary oxygen-therapy in chronic hypoxic cor-pulmonale complicating chronic-bronchitis and emphysema. Lancet. 1981; 1:681-6.
  11. Ando T, Yamaki K, Takagi K, Ogawa K, Hara M. Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in subjects with chronic respiratory diseases. Chest. 1996; 110:462-8.
  12. Schönhofer B, Barchfeld T, Wenzel M, Köhler D. Long term effects of non-invasive mechanical ventilation on pulmonary haemodynamics in subjects with chronic respiratory failure. Thorax. 2001; 56:524-8.
  13. Budweiser S, Luchner A, Jörres RA, Heinemann F, Hitzl AP, Schmidbauer K, et al. NT-proBNP in chronic hypercapnic respiratory failure: a marker of disease severity, treatment effect and prognosis. Respir Med. 2007; 101:2003-10.
  14. Greenbaum D, Millen JE, Eross B, Snyder J, Grenvik A, Safar P. Continuous positive airway pressure without tracheal intubation in spontaneously breathing subjects. Chest. 1976; 69:615-20.
  15. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981; 1:862-5.
  16. Bott J, Carroll M, Conway J, Keilty S, Ward E, Brown A, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet. 1993; 341:1555-7.
  17. Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med. 1995; 151:1799-806.
  18. Pandey R, Chokhani R. Use of non invasive ventilation in subjects with respiratory failure in nepal. Kathmandu Univ Med J. 2012; 9:256-9.
  19. Peter JV, Moran JL, Phillips-Hughes J, Warn D. Noninvasive ventilation in acute respiratory failure--a meta-analysis update. Crit Care Med. 2002; 30:555-62.
  20. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995; 333:817-22.
  21. Thorens JB, Ritz M, Reynard C, Righetti A, Vallotton M, Favre H, et al. Haemodynamic and endocrinological effects of noninvasive mechanical ventilation in respiratory failure. Eur Respir J. 1997; 10:2553-9.
  22. Bando M, Ishii Y, Sugiyama Y, Kitamura S. Elevated plasma brain natriuretic peptide levels in chronic respiratory failure with cor pulmonale. Respir Med. 1999; 93:507-14.
  23. Dursunoglu N, Dursunoglu D, Moray A, Gur S. Acute improvement of pulmonary artery pressure by non-invasive positive pressure ventilation in the subjects with hypercapnic respiratory failure. Tuberk Toraks. 2010; 58(4):418-24.
Journal of Cardio-Thoracic Medicine
Volume 5, Issue 2
June 2017
Pages 558-563

Files

Share

How to cite

Statistics