European Journal of Molecular & Clinical Medicine

Abstract

Aim: To evaluate the role of   non-invasive ventilation (NIV) for treatment of acute respiratory failure (ARF) among patients with noncystic fibrosis (CF) bronchiectasis.
Methods: This was a prospective study conducted in the Department of Anaesthesiology, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. We included 130 patients with bronchiectasis and ARF who required either NIV or invasive mechanical ventilation (IMV).
Results: Out of 250,130 patients who required either NIV or IMV. The most common etiology of bronchiectasis was post‑tuberculosis (53%) followed by idiopathic (23%), ABPA (17%), and immunodeficiency (7%). NIV was initiated as first line of ventilator support for 100 patients. Among these, 66(66%) were managed successfully with NIV. 34 (34%) 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=15), hypotension (n = 7), worsening of sensorium (n = 5), and intolerance (n = 6). NIV was initiated as first line of ventilator support for 100 patients. Among these, 66(66%) were managed successfully with NIV. 34 (34%) 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=15), hypotension (n = 7), worsening of sensorium (n = 5), and intolerance (n = 6). NIV failure occurred after a median duration of 2.72(95% confidence interval [CI]-1.52–4.42) days after the initiation. The comparison of total duration of stay in hospital, number of days spent on ventilator support and mortality rate between NIV and IMV are shown in Table 2. There were total 15 deaths in the study group. Among patients who failed NIV, total days (median [range]) spent on ventilator (6.8 [2–63] vs. 6.2 [3–17] days; P = 0.31), duration (median [range]) of hospital stay (7.5 [4–63] vs. 12 [5–16] days; P = 0.27), and mortality (11 [11%] vs. 4 [13.33%]; P = 0.24) were comparable to the IMV group.
Conclusion: NIV is feasible for management of ARF with non-CF bronchiectasis. High APACHE may predict NIV failure among these patients.