The Observation Of Early Application Effectiveness Of NIV Home Ventilation In Acute Exacerbations Of Chronic Obstructive Pulmonary Disease

Background: Acute exacerbation of chronic obstructive pulmonary disease(COPD),which is an important event in the progression of COPD, is the main factor leading to hospitalization and reduced the quality of life, as well as the main factor for lung function accelerating decline, increasing the chance of patients with tracheal intubation and mortality, increasing burden of socio – economic. Accompanied with type II respiratory failure in acute exacerbation of COPD patients, can induce some severe complications including pulmonary encephalopathy, multiple organ dysfunction syndrome( MODS), serious acid-base imbalance and even lead to death. Therefore, early treatment of acute exacerbation is especially critical to alleviate the suffering and economic burden for COPD patients. Early recieving noninvasive ventilation at community or outpatient,moderate to severe COPD patients with acute exacerbation can achieve the effect such as decreased respiratory rate and relief dyspnea, shorten acute exacerbation of course,decreased hospitalization rates or the average length of hospitalized stay, reduced the number of exacerbations,endotracheal intubation,mortality, lower in patients with acute exacerbation of economic costs, thereby reducing the social and economic burden, improve the researching level of comprehensive treatment and prevention for COPD complicated with respiratory failure.Methods: Our trial was conducted from January to December of 2014 in the Lvshunkou District Community Hospital, outpatient of secondary and tertiary hospital of Dalian. Subjects were enrolled when they were diagnosed COPD according to GOLD Guide published in 2011, and classified as B, C, grade based on their lung function test. We randomly allocated them into ventilation group and control group, and they were given the following routine therapies: antibiotics, relieving asthma treatment and dispelling phlegm. Non- invasive ventilation therapy was given in the ventilation group, ventilation mode was set as S / T model. Data of heart rate, respiratory frequency and oxygen saturation at 2hours, day1, day3 and da y7 after the treatment was collected from the subjects of the two groups. T-test was used to assess the statistical difference between the two groups, software SPSS 2.0 was used to conduct the calculation. We sought to evaluate the effect of non- invasive ventilation therapy on COPD patients based on the data we collected.Results: 1.No statistical difference was observed of comparing baseline characteristics between the two groups. Respiratory frequency of ventilation group was significantly higher than co ntrol group at day3 and day7( P<0.05), no difference in heart rate and oxygen saturation was found between the two groups at day1, day3 and day7 after the treatment(P>0.05). 2. In the control group, one case was hospitalized due to dyspnea, and mMRC garde record at day7 was not reduced compared with pre-treatment and day1. Dyspnea was improved in the remaining patients, and mMRC garde record did not increased compared with pre-treatment. In the control group, clinical parameters, such as heart rate and respiratory frequency was reduced at day1, day3 and day7 after the treatment, oxygen saturation was increased compared with pre-treatment, however, there improvements did not reach statistical difference(P>0.05). 3. Dyspnea was improved in all the subjects in the ventilation group, mMRC garde record at day1 and day7 of treatment did not increased compared with pre-treatment, none of these patients was hospitalized and no complications were observed. Heart rate and respiratory frequency was reduced, oxygen saturation was increased compared with pre-treatment. Compared with pre-treatment, heart rate was significantly reduced at day3 and day7 after non- invasive ventilation therapy(P<0.05). The same statistical difference was observed in the dynamic change of oxygen saturation at 2hours, day1 and day3 after non- invasive ventilation therapy, compared with pre-treatment(P<0.05).Conclusions: 1.Compared with conventional therapy alone, early application of non- invasive ventilation therapy in COPD patients was assoc iated with rapid resolution of dyspnea and reduced hospitalization. 2. Non-invasive ventilation therapy was associated with improved oxygen saturation and decreased tissue hypoxia in AECOPD patients, thus diminishing the likelihood of ICU admission and endotracheal tube intubation and improving prognosis, which helped to reduce the economy burden of those patients. 3. Early application of non- invasive ventilation therapy in COPD patients is of great clinical value, this strategy is worthy of extensive clinical practice for its potent efficacy and mild complications.