Non-Invasive Ventilation - Literature review Example

Chronic obstructive pulmonary disease (COPD) is among the leading global causes of chronic morbidity and mortality, being listed as the 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).

The excessive decline of lung function in patients with COPD leading to hospitalization and death due to COPD is associated with the 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), characterized by deterioration in gas exchange, along with tachypnoea, dyspnoea, and crepitation (Brochard, 2000); as was observed in the case study by the author. Studies have recommended the use of Non-invasive ventilation (NIV) in such cases of exacerbations of COPD (Dikensoy et al., 2002). However, there are controversies to the 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 the severity of exacerbations and respiratory acidosis, several other factors such as individual characteristics, the timing of intervention, the skill of the operating team, available facilities, and cost factors (Plant et al., 2003) need to be considered. Clinicians recommend the use of NIV routinely in acute hypercapnic COPD exacerbations except in the advanced cases of respiratory failure or in cases of contraindications (Tomii, et al., 2009).