Health Condition 1: J441- Chronic obstructive pulmonary disease with (acute) exacerbation
Conditions
Interventions
Intervention1: iVAPS mode: Based on patientâ??s height targeted alveolar ventilation will be adjusted with a Tidal Volume of 8 ml/kg of ideal body weight. Expiratory Positive Airway Pressure (EPAP) w
Minimum and maximum Pressure Support (PS) will be 8-20 cm of H20 will be set and adjusted as per the need of the patient. Day 0 NIV application will be continuous and duration of 16-18 hours, On day
Sponsors
AIIMS Rishikesh
Eligibility
Inclusion criteria
Inclusion criteria: Indication for NIV post extubation (any one of the following high-risk criteria): 1.Underlying chronic obstructive airway disease (COAD) with paco2 >45 mm Hg at extubation 2.Age >65 years 3.History of chronic heart failure (New York Heart Association class II-IV) or left ventricular ejection fraction 4.Prior failed spontaneous breathing trial 5.Two or more organ system failure other than chronic respiratory or heart failure. Inclusion criteria: 1.Acute exacerbation of COPD patient requiring Invasive Mechanical Ventilation (IMV) for at least 24 hours. 2.Patient on IMV fulfilling extubation criteria and passing spontaneous breathing trial. 3.Patient on IMV planned to put on NIV support post extubation for any one of the above mentioned high risk criteria.
Exclusion criteria
Exclusion criteria: 1.Other chest diseases (ILD, bronchiectasis, Concomitant malignancy). 2.Contraindications to NIV application (example: craniofacial trauma or surgery, ongoing upper gastrointestinal bleeding, excessive respiratory secretions or inability to handle secretion, recurrent vomiting, tracheotomised, etc.) 3.Patient not giving consent to participate in the study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1.Success rate of either mode: Success will be considered when the patient is able to achieve the following: pH 7.35, decrease in partial pressure of carbon dioxide (PaCO2) of 15-20%, partial pressure of oxygen (PaO2) 60 mmHg, arterial oxygen saturation (SaO2) 90% on fraction of inspired oxygen (FiO2) 40%, RR 24 bpm and no signs of respiratory distress like agitation, diaphoresis or anxiety.Timepoint: 72 hours post extubation | — |
Secondary
| Measure | Time frame |
|---|---|
| Degree of patients comfortTimepoint: Twice a day till on NIV support;Duration spent on NIVTimepoint: Till discharge from ICU;Length of ICU stayTimepoint: Till discharge from ICU;Re-intubation rate in each groupTimepoint: 72 hours from extubation | — |
Countries
India
Contacts
Public ContactPrakhar Sharma
AIIMS Rishikesh
Outcome results
None listed