Abstract
Aim: To compare the effectiveness of BiPAP in patients with normal Glassgow Coma Scale (GCS) to those having impaired consciousness (GCS in between 10-14) in COPD exacerbation with hypercapnic encephalopathy.
Methods: This comparative study was conducted in a Medical Intensive Care Unit of lttefaq Hospital Model Town Lahore from 1st June 2015 to 30th November 2015. Ninety patients admitted with acute exacerbation of COPD were studied. Base line reading of arterial blood gas (ABGs) was taken in all patients. Level of consciousness was assessed by GCS. Patients with GCS above 10 were put on BiPAP ventilation. Arterial blood gas analysis was repeated at 2 hours. Patients were divided in to two groups. One group with normal GCS (15/15) and other with GCS 10-14. Effectiveness of BiPAP was compared in both groups in term of improvement in ABGs.
Results: ABG readings improved in both groups at 2 h. Success rate with noninvasive positive pressure ventilation in the form of BiPAP was up to 98.5% in group with normal GCS compared to 37.5% in low GCS group.
Conclusion: If medical therapy fails in acute exacerbation of COPD, the Non Invasive mechanical ventilation in the form of BiPAP should be applied even in low GCS settings in patients with hypercapnic encephalopathy prior to deciding about conventional invasive ventilation.