According to research published in the journal Medicine, for patients with acute COPD exacerbations and hypercapnic encephalopathy, noninvasive positive-pressure ventilation (NPPV) combined with a noninvasive strategy to clear secretions during the first two hours may be more beneficial than conventional mechanical ventilation (CMV).
A total of 74 patients received NPPV, and 90 patients received CMV. Inclusion criteria included physician-diagnosed acute exacerbations of COPD, spontaneous airway clearance of excessive secretions, arterial blood gas analysis requiring intensive care, moderate-to-severe dyspnea, and a Kelly-Matthay Scale score of 3 to 5.
According to the researchers, arterial blood gases and sensorium levels improved significantly within 2 hours among patients in the NPPV group, with lower hospital mortality, fewer complications and invasive devices per patient, and superior weaning off of mechanical ventilation. Mechanical ventilation duration, hospital stay, and 1-year mortality were similar between the 2 groups.
“The use of an oropharyngeal airway and suction aspiration, in combination with appropriate positioning of the patient and nebulized inhalation of salbutamol/ambroxol, was a feasible, simple, safe, and effective method for clearing respiratory secretions during the first 2 hours of NPPV in patients in the ICU with acute exacerbations of COPD and hypercapnic encephalopathy,” stated the study authors.