Retrospective evaluation of sequential invasive and noninvasive ventilation in treatment of hyperapneic respiratory failure and pulmonary encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease

Objective To evaluate the therapeutic effects of sequential invasive to noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease(COPD) complicated with hypercapneic respiratory failure and pulmonary encephalopathy.Methods The studied cases were assigned to 2 groups:invasive ventilation group(n=146) and sequential invasive to noninvasive ventilation group(n=128).Pulmonary infection control window(PICW) was defined as switching point from invasive ventilation to noninvasive ventilation.The main clinical parameters observed were:the invasive ventilation period,total ventilation period,reintubation rate within one week,length of stay in respiratory intensive care unit(RICU),and incidence of ventilator-associated pneumonia(VAP).Results The invasive ventilation period and length of stay in RICU of the cases with sequential invasive to noninvasive ventilation group were significantly shorter than that in invasive ventilation group(5.8±4.2d vs 12.4±8.6d,P0.05;10±7d vs 15±11d,P0.05).Incidence of VAP and reintubation rate were lower in sequential invasive to noninvasive ventilation group than that in invasive ventilation group(4.7% vs 21.8%,P0.05;6.2% vs 16.4%,P0.05).Conclusion The result of sequential invasive to noninvasive ventilation is better than that of invasive ventilation for COPD with acute exacerbation resulting in hypercapnic respiratory failure and pulmonary encephalopathy as shown by effectively decreasing the invasive ventilation period and length of stay in RICU,reducing the incidence of VAP and improving the patients' prognosis.