Comparing effectiveness of intelligent volume-assured pressure support (iVAPS) vs bi-level positive airway pressure spontaneous/timed (BPAP S/T) for hypercapnic respiratory failure in chronic obstructive pulmonary disease

Noninvasive positive pressure in acute exacerbations of chronic obstructive pulmonary disease

PURPOSE OF REVIEW

Noninvasive positive pressure ventilation (NIV) is standard of care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We review the most current evidence and highlight areas of uncertainty and ongoing research. We highlight key concepts for the clinician caring for patients with AECOPD which require NIV.

RECENT FINDINGS

Implementation of NIV in AECOPD is not uniform in spite of the evidence and guidelines. Initiation of NIV should be done early and following protocols. Low-intensity NIV remains the standard of care, although research and guidelines are evaluating higher intensity NIV. Scores to predict NIV failure continue to be refined to allow early identification and interventions. Several areas of uncertainty remain, among them are interventions to improve tolerance, length of support and titration and nutritional support during NIV.

SUMMARY

The use of NIV in AECOPD is the standard of care as it has demonstrated benefits in several patient-centered outcomes. Current developments and research is related to the implementation and adjustment of NIV.

The Significance of Implementing Bilevel Positive Airway Pressure under Cluster Nursing in Improving the Survival Possibility of Patients with Severe Pulmonary Infection Complicated by Respiratory Failure

Objective. To explore the significance of bilevel positive airway pressure (BIPAP) under cluster nursing in improving the survival probability of patients with severe pulmonary infection (SPI) complicated by respiratory failure (RF). Methods. This research included 153 SPI patients complicated by RF ( $\text{SPI}+\text{RF}$ ) admitted between January 2020 and March 2022, including 55 cases in group A who were treated with BIPAP under cluster care during hospitalization, 47 cases in group B receiving invasive continuous mechanical ventilation during hospitalization, and 51 cases in group C treated with BIPAP under routine care during hospitalization. The three cohorts were compared regarding pre- and posttreatment serum inflammatory factors (IFs), blood gas (BG) parameters, heart rate (HR), and respiratory rate (RR). Besides, the cumulative time of ventilator use, successful ventilator weaning rate, mortality, and incidence of adverse events were counted. Finally, patients were scored for their psychological state using the Hamilton Anxiety/Depression Scale (HAMA/HAMD). Results. The posttreatment TNF-α, IL-6, PCT, WBC, and PaCO2 reduced statistically in all the three groups, with the lowest levels found in group A and the highest in group B ( $P<0.05$ ); while PaO2 and SpO2 increased, with the highest values found in group A and the lowest in group B ( $P<0.05$ ). Among the three groups, group A had the shortest duration of ventilator use, the highest successful weaning rate, and the lowest incidence of adverse events ( $P<0.05$ ). Besides, HAMA and HAMD scores were the lowest in group A among the three groups, while those in group B were higher compared with group C ( $P<0.05$ ). Conclusion. The implementation of BIPAP under cluster nursing can effectively reduce inflammatory responses of $\text{SPI}+\text{RF}$ patients, improve their vital signs, and enhance their psychological state, which has extremely high clinical application value.