Outcome of Ventilatory Supports in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) leads to significant morbidity and mortality and is the third leading cause of death in the world. The patient having an episode of acute exacerbation of chronic obstructive pulmonary disease (AE of COPD) may require hospital admission including intensive care unit (ICU) admission due to respiratory failure.. Ventilatory support have shown significant outcomes in recovery of the patients. There are limited studies on this subject in Nepal and in our region.

Methods: This retrospective study was conducted to describe clinical profile of patients diagnosed with AE of COPD in Chitwan Medical College Teaching Hospital (CMCTH), a tertiary care centre in Nepal during 1year period from February, 2022 to January, 2023. Data were collected from hospital medical records. All cases of AE of COPD were included in this study after excluding patients with primary diagnosis of restrictive lung disease causing hypercapnia and patients being treated with non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP).

Results: A total of 502 cases presented to our hospital during the one year period. Among them, 64.4% were female. Most of the patients belonged to the age group of 50-80 years. 24.30% were under ventilatory supports. Among all patients (122) under ventilatory supports, 56.55% patients were under non-invasive ventilation (NIV) and 43.44% were under invasive mechanical ventilation (IMV). 21% patients left against medical advice (LAMA), 25% on discharge on request (DOR), 51.99% patients were discharged with full recovery, whereas mortality with treatment was 2.19%.

Conclusion: Patients with AE of COPD were admitted in significant numbers which was seen more prevalent in females and older age group. Ventilatory support is widely used in the management, with NIV being more preferred over IMV and has proven to be effective in reducing complications and mortality rate.