A review of the literature exploring the user of NIV to treat exacerbation of COPD - Dissertation Example

?Running head: A review of the literature exploring the user of NIV to treat exacerbation of COPD City, State Date A review of the literature exploring the user of NIV to treat exacerbation of COPD A plethora of researches have been conducted with an objective of investigating the utilization of NIV in treatment of exacerbations of COPD, which have gone to extremity or have reached an acute stage. The main objective of this paper is to review what has been found by various studies on the survival challenges, quality of life and the compliance to NIV therapy by the users. Also, the paper will review literature on the effectiveness of the NIV treatment. Challenges on survival, Quality of life and compliance to NIV therapy According to the studies by Massimo, et al (2012, pp747), it was gathered that there are indications of early NIV positive pressure ventilation, which tend to increase the rate of survival. This was made in comparison with NIPPV. As such, NIV acts as a relief from challenges relating to survival rate in patients with high level of CO2 in their blood. A study by Pepin, et al (2008, pp360) indicates these challenges. According to the study, the challenges that these patients face are: fatigue, sleep patterns that are disturbed as well as breathlessness. The group also found out that NIV does not provide a prevention against weakening of the respiratory muscle that tend to progress. Acute exacerbations of a chronic Obstructive Pulmonary Disease better referred to as COPD, pose great challenge to the survival rate of a patient. In the periods that the patient is faced with worsening extremes, it adversely affects the patient’s health status. There is an escalating admission to hospitals and even rise of mortality rates (Angus, et al 2011, pp84). According to the studies by Fionnuala, et al (2007, pp60), it is approximated that the mortality rate of in-patient ranged from 4%-30%. The study goes on to indicate that patients that are admitted due to complications from acute Respiratory failure have a higher mortality rate. According to the study, the patients who are elderly and have co morbidities as well as those patients needing the ICU facilities were the most affected by the high mortality rate. According to the study by Monica, et al (2004, pp605), ventilation of the respiratory worsens to perfusion ratio and this result to a mechanism in the hypoxemia occurrence. This happens when psychological dead space enlarges. It also occurs when there is a rise in the ventilation waste. In the study by Suzy (2012, pp61), it was identified that increased resistance of the airway as well as the need for high minute ventilation tend to result to a limitation on the expiratory flow. Still, the study found out that a dynamic hyperinflation, enlarged threshold of the aspiratory load as well as respiratory muscle dysfunction result to a feeling of fatigue in a patient. Plant and Elliott (2003) studied that a rapid pattern of breathing, which is somehow shallow, occurs. This is due to the respiratory system efforts towards maintenance of enough ventilation in the alveoli. This happens when the elastic, resistive and loads of aspiratory threshold are introduced to the weakened muscles of the respiratory system. However, irrespective of an increment in stimulus of the centers of the respiratory system as well as swings in the large, negative intra-thoracic pressure, carbon dioxide is still retained and as such, acedemia occurs. Other studies by Rossi, et al (1995) and Ambrosino, et al (1997) established that severe COPD which is complicated by ARF, attain characteristics such as; right ventricular failure, encephalopathy as well as dyspnea and these pose as serious challenges to the survival of the patient. In regards to the studies by Eliott (2012, pp85), a vital intervening is advantageous to the patient with COPD is advisable. He suggested a clinical experience and this was an NIV treatment. Does NIV improve respiratory function or increase survival? A study by Gbs (2004, pp204) concluded that NIV treatment prolonged the rate of survival and that it was an effective treatment in slowing the FVC decline. How Does NIV affect the quality of life? The studies by Gbs (2004, pp202) established that, NIV treated patient had a positive impact on his life quality. As such, there was a tremendous improvement in the patient. This improvement was seen in different aspects of life. They included; vitality, somnolence during daytime, problems of concentration, energy, as well as quality of sleep. In one of the group’s numerous studies, it was found out that patients treated under NIV showed an increase in the quality of life. As such, this increase exceeded baseline of 75%. As a result, it increased the weighted mean of time and hence on average, quality of life was improved. According to these studies, it was found out that most patients that used NIV or TIV used them again. The studies further concluded that NIV weans an effective treatment since it favored the patients but on the other hand, it posed as encumber to the NIV practitioners. Several factors influence of COPD patients towards using NIV treatment. According to the study by Eric (2007, pp190), compliance of the patients to NIV is accelerated by nocturnal oximetry. As such, it was found that it detected respiratory shortcomings early enough thus necessitating compliance with NIV. Again, involving Bulbar as well as dysfunction that is executive in nature results to a lowered compliance with treatment using NIV. Eric (2007, pp190) made a conclusion that, an NIV user, in treatment of acute COPD, had significant benefits. As such, the need for endotracheal intubation (ETI) was reduced by 66%, mortality was reduced by 20%, the length of stay in ICU (LICUS) was reduced to 19 days and the length of hospitality stay (LHS) was reduced to 13 days. Efficiency of NIV treatment In a meta-analysis by Stefano (2011, pp257), a review on the utilization of NIV in the treatment of an acute problem of a failure in the respiratory system was done. The results of this review was that a there was a notable reduction of the need for the numbers that are needed to treat six (ETI). In addition, they found out that LHS decreased to 2.74 days. Further, they observed that there was a reduction of relative risk for all group’s mortality rates amounting to 45%. What was the most striking were the results of COPD. Their conclusion was that, the most apparent effects in patients who have acute failure in their respiratory system secondary to chronic pulmonary disease exacerbations, which is obstructive, were the effects of noninvasive ventilation. Stefano (2011, pp259) conducted a cohort study, which was prospective. He made an investigation on the use of NIV as well as BIPAP and ventilation that has a negative pressure. According to the findings of this group, there was a reduced need for ETI in addition to the reduction in the rate of mortality with NIV treatment. Further, they established that a combination backup of positive pressure and negative pressure in the cases of treating failure of the respiratory system was beneficial. Efficiency of NIV in treating a patient with Pulmonary Oedema (PO) While a theoretical benefit to a patient of pulmonary oedema is provided by NIV, it necessitates one to ask whether this decipher into a benefit, which is clinical. The basis of the report by Sabatini & Marco (2006, pp547) is the 39 patients who have a serious cardiogenic PO randomized to CPAP (n=19) or oxygen therapy (n=20). The group’s focus was on the conversion to intubation, the change to blood gases in the artery as well as the length of stay in the ICU. These formed the basis to which the outcome would b intubation e measured. The result was that, CPAP could give rise to improved early physiology and still lead to reduction for intubation need as well as mechanical ventilation. In a study by Andrea (2000, pp689), it was reported that there is a cost benefit analysis of treating every suffering from severe Cardiogenic Pulmonary Oedema, CPO, patient using a mask NIV. This is not the case where admission of patients who fail the convectional non-CPAP treatment and who require mechanical ventilation was to be advocated. According to the group, there was a reduction of 35% to 0% in the need for mechanical ventilation. The cost that had been estimated before on a yearly basis showed that, there was a caseload of 35 ventilated casualties (176,925 dollars) which exceeded the cost relating to escalated caseload of 100 NIV casualties (115,600 dollars). In a trial data brought forward by Antoine, Paolo, Inga, Graeme, et al (2011, pp1226) made a comparison between NIV and BIPAP. In addition, this comparison was made regarding the convectional oxygen therapy. It was found out that treatment which involved NIV led to increased improvement in the psychology of casualties as well as decrease in mortality rate, that is, a 30% reduction, p=0.029. In their conclusion, Crane stated that casualties who presented an acute cardiogenic PO and acidosis, had an upper hand to survive after being discharged from the hospital if treated with CPIP as compared to treatment using bi-level ventilation or even convectional oxygen therapy. In a study by Monica, et al (2007, pp35), after undergoing major surgery in the abdomen, the patients rates of intubation, infection, pneumonia as well as sepsis, were lower as compared with casualties who had oxygen treatment. As such, it was evident that, the mean days (SD) spent in the intensive care facilities without any deaths were few. This is a contrasting feature regarding oxygen treatment as 3 of those treated with oxygen alone died. Other possible causes of failure in the respiratory As mentioned above, trial data is limited concerning the treatment of other causes of failure of the respiratory system. Studies on Asthma are few. An example of this is a study by Meert & Berghmans (2006, pp92). The group did trials on CPAP in treating asthmaticus status. As such, she patients treated signified improvement in their psychology after treatment and later, there was no case of another long-term result. Usage of NIV in other causes of the failure of the respiratory system is few. According to Nicholas, et al (2010, pp110), NIV tends to be effective when treating pneumonia cases. In reality, NIV improves the oxygenation. Irrespective of this fact, there a limited evidence which can be used in support of ETI rate reduction. However, there was a report by Lokesh & Nigel (2009, pp103) on immune-suppressed casualties in cases of acute failure of the respiratory. This study does not include COPD and the PO. Instead, it puts its focus on other causes of an acute failure in the respiratory system as discussed above. The results showed that there was a considerable reduction in the rate of ETI (p=0.03) as well as reduced mortality, (p=0.03). In the study, there is no distinction in either the LICUS or the ventilation mean duration. According to the study by Antonelli, et al (2011, pp17), a similar set of outcomes were evident in the study of solid transplant casualties concerning the cases of respiratory failure. The group shows that, in this subgroup, a significant P1 (P=0.03), a reduced ETI rate (? 50% P=0.002), reduced LICUS, (? 3.5 days p=0.03) as well as a reduced mortality happening in ICU (? 30% p=0.05). Another study by Lokesh & Nigel (2011, pp103) was done on the treatment of casualties who suffered from acute failure of the respiratory (ARF) which was secondary to the congestive heart failure (CHF). Out of the 54 patients meeting the criteria of intubation, there were only for failures concerning NIV and thus required intubation. As such, ICU reduced from 100% to 48%. In addition, the average period of ICU stay lowered from 14.8 days to 8 days. Endotracheal Intubation ETI Notably, the fact that NIV is capable of reducing the necessity for endotracheal intubation, is the most predominant outcome in all the papers under review that is, (1,2,3,4,5,6,7,8,9,13,15,16, and 18). The influence of this is removal or shortening of the LICUS. As a result, cost is reduced. For instance, an informed estimate is that, an ICU bed costs $ 1800 per day in New Zealand. The utilization of NIV can lead to reduction of the cost hence saving a significant amount of finances for the entire health system. In addition to this, a further study by Longest (2011, pp109) identified a significant nosocomial infection reduction in their rates when making a comparison between ETI and NIV. According to the group’s conclusion, the casualties processing acute COPD exacerbations, treated with NIV, tends to have a reduced rate of infection, reduced mortality as well as declining ICU stay period. A study similar to this conducted by Wen-Kuang, et al (2011, pp1188) brought out a huge decrease concerning the overall rate of infection as well as the ventilator relating to rate of pneumonia. The moment the patients have undergone intubation, complications may arise. Consequently, some patients may depend on the ventilator. There have been several trials, which have been conducted on CPAP as a strategy of ventilator weaning. NIV was depicted to cause a reduction in the mortality, ventilator relating to the span of a patient’s stay in ICU or In the Hospital in ETI ventilated patients as well as pneumonia ventilation. Wen-Kuang, et al (1191) conducted this in a research. The most fascinating this was that, the utilization the NIV failed to reduce the amount of failures associated with winning, in a significant manner. Conclusion Use of NIV is effective in treating failures of the respiratory system, which result from either COPD or from Pulmonary Oedema. Positive evidence exist signifying use of NIV which is useful in treating other causes that bring about, the failure in the respiratory system. This is in regard to the patient subgroups selected. In addition, plenty of studies have depicted NIV as a useful method to treat certain conditions including CABG operation recovery as well as abdominal surgeries that are deemed major. As such, NIV is a therapy established in the area of premature respiratory support in infants. Still, it is said to be useful in weaning of casualties from ETI ventilation. Again, NIV has a distinguished advantage in that it reduces the need for ETI significantly. As such, there are plentiful advantages especially to the patient. In the real sense, ETI is an undesirable procedure. NIV gives patients a piece of mind as it is an alternative to ETI. Its use is incorporated without any disregard of the objectives of therapy. As such, NIV enables a patient to communicate without interference of the tube installed in the throat. This is an advantage to a patient who has a terminal illness. Concerning the system of health, avoidance of ETI results to ICU beds being put into use since NIV is delivered in the ward. Further, NIV has a relationship with decreased nasocomial infection rate meaning that the user of NIV utilizes antibiotics in low volumes as well as the medical practitioner’s time. Consequently, this translates to short stays in hospitals in additions to the savings by the NIV user. To add to this, there are cases where the NIV user, tend to reduce both LHS and LICUS. Therefore, NIV is an effective treatment as the user feels the advantages of the method being friendly to him. References Andrea, R. 2000. Noninvasive Ventilation Has Not Been Shown To Be Ineffective in Stable COPD. Journal of Respiratory and Critical Care Medicine, 161(3). Pp. 688-689 Angus, A., et al. 2011. Acute on chronic ventilatory failure managed successfully with non-invasive ventilation XMPMA. 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