Prospective, randomized double blinded clinical comparative study of noninvasive ventilation for acute respiratory failure due to noncystic fibrosis bronchiectasis
Author(s): Dr. G Bhavani and Dr. Ravinder B
Aim: The aim of this study to evaluate the role of noninvasive ventilation (NIV) for treatment of acute respiratory failure (ARF) among patients with noncystic fibrosis (CF) bronchiectasis.
Material and Methods: This was a Prospective, randomized double blinded clinical comparative study conducted in the Department of Anaesthesiology, RVM institute of medical sciences & research centre, India for the period of 2 years. We included 100 patients with bronchiectasis and ARF who required either NIV or invasive mechanical ventilation (IMV).
Results: There was a total of 232 patients with bronchiectasis, among these, 100 patients were admitted with ARF. Totally 100 patients who required either NIV or IMV. The most common etiology of bronchiectasis was post-tuberculosis (50%) followed by idiopathic (20%), ABPA (15%), and immunodeficiency (5%). NIV was initiated as first line of ventilator support for 80 patients. Among these, 51(63.75%) were managed successfully with NIV. 29 (36.25%) patients failed NIV and required endotracheal intubation during the hospital stay. Reasons for NIV failure were worsening or non-improvement of ventilatory or oxygenation parameters (n=14), hypotension (n=6), worsening of sensorium (n=4), and intolerance (n=5). NIV failure occurred after a median duration of 2.77(95% confidence interval [CI]‑1.51–4.24) days after the initiation. There were total 11 deaths in the study group. Among patients who failed NIV, total days (median [range]) spent on ventilator (6.6 [2–62] vs. 6.1 [3–16] days; P=0.41), duration (median [range]) of hospital stay (8 [4–64] vs. 11 [5–15] days; P=0.27), and mortality (8 [10%] vs 3 [15%]; P=0.24) were comparable to the IMV group. The causes of death among patients who failed NIV were septic shock (n=5) and ventilator‑associated pneumonia (n=3).
Conclusions: NIV is feasible for management of ARF with non‑CF bronchiectasis. High APACHE may predict NIV failure among these patients.
Dr. G Bhavani, Dr. Ravinder B. Prospective, randomized double blinded clinical comparative study of noninvasive ventilation for acute respiratory failure due to noncystic fibrosis bronchiectasis. Int J Adv Res Med 2021;3(2):621-625. DOI: 10.22271/27069567.2021.v3.i2i.395