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Abstract
ARF on top of COPD represents one of the commonly daily encountered medical emergencies in the respiratory ICU.
In conscious cooperative COPD patient, controlled oxygen therapy plus standard treatment regimen (antibiotic, bronchodilators, heparin, diuretic... etc.)
constitutes well-established therapeutic mode in the management of COPD patient
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with ARF. If these measures iail to correct the dangerous hypoxaemia with deterioration in arterial CO2 tension and/or conscious state, mechanical ventilation with endotracheal intubation deemed necessary. Yet this treatment modality is regarded as double-edged sward that might be associated with unwanted (immediate and late) complications.
Since renovation of non invasive positive pressure ventilation in 1960, it becomes the first line management of acute respiratory failure in properly selected group of COPD achieving high success rate and saving these patients from undesirable complications of the conventional mechanical ventilation.
The aim of this work is to evaluate the efficacy ofbilevel positive airway pressure (BiPAP) ventilation versus controlled oxygen therapy in the management of acute exacerbation of COPD.
This study covered 20 patients with acute exacerbation of COPD that have been admitted to the respiratory intensive care unit of the Chest Diseases Department-Faculty of Medicine-Alexandria University, from May 1999 to May 2000 with the selection criteria of history of COPD, clinical Criteria of acute exacerbation [ increase severity of dyspnea (respiratory rate > 25 breaths/min.), tachycardia (Heart rate > 110 beats/min.), change in the aspect of sputum as regards colour and amount, the use of accessory muscles of respiration, airway obstruction, worsening cyanosis ], ABG criteria ( Pa02 < 55 mmHg, PaC02 > 50 rnmHg, pH < 7.35 ), conscious and cooperative patient, cardiovascular stability (niether Hypotension, nor dysrhythmia ).
Each patient was subjected to history taking, clinical examination, laboratory investigations ( Hb%, RBC coumt, WBC count, Htc, SGOT, S