Wednesday, September 11, 2019

Non-Invasive Ventilation in Severe Acute Respiratory Failure (ARF) Literature review

Non-Invasive Ventilation in Severe Acute Respiratory Failure (ARF) secondary to an Acute Exacerbation of Chronic Obstructive Pul - Literature review Example Figure 3: Kaplan-Meier plot showing cumulative survival following the initiation of NIV (Chung et al., 2010) 18 Introduction Chronic obstructive pulmonary disease (COPD) is among the leading global causes of chronic morbidity and mortality, being listed as fourth leading cause of death worldwide (British Lung Foundation, 2007). It accounts for approximately 30,000 deaths each year in the United Kingdom (UK) , with more than 90% of these occurring in the over 65 age group "in 2004" (Healthcare Commission, 2006). The prevalence of the disease is expected to rise in coming decades and it is projected to be the third leading cause of death worldwide by 2020 (Murray and Lopez 1997). A disorder with chronic airflow limitation, the definition of COPD now gaining acceptance defines COPD as â€Å"a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal; inflammatory response of the lun gs to noxious particles or gases† (GOLD, 2010). Three general types of lesions are associated with COPD: emphysema, small airways inflammation and fibrosis, and mucus gland hyperplasia (Senior & Anthonisen, 1998). Excessive decline of lung function in patients with COPD leading to hospitalisation and death due to COPD is associated with presence of chronic mucus hypersecretion (Vestbo & Lang, 1996). Tobacco use is definitely the major risk factor for COPD defined by pack-year or cumulative dose, besides other risk factors such as age (Blanchette et al., 2011), familial tendencies, childhood respiratory diseases, (Senior & Anthonisen, 1998) and occupational exposure (Tomas, 2011; Blanc et al., 2009) Up to 20% of COPD patients admitted to hospital present with respiratory acidosis (Plant, 2000), characterised by deterioration in gas exchange, along with tachypnoea, dyspnoea, and crepitation (Brochard, 2000); as was observed in the case studied by the author. Studies have recomme nded the use of Non-invasive ventilation (NIV) in such cases of exacerbations of COPD (Dikensoy et al., 2002). However, there are controversies to selection of patients who may be considered eligible and may actually benefit from NIV due to methodological factors. Patients with exacerbations of COPD who are not likely to respond to conventional support therapy and those in which NIV can be used for averting the needs of invasive mechanical ventilation can be selected for administration of NIV (Garpestad et al., 2007). Besides severity of exacerbations and respiratory acidosis, several other factors such as individual characteristics, timing of intervention, skill of operating

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