Evaluation of the Efficacy of Non-Invasive Mechanical Ventilation and High-Flow Nasal Oxygen Therapy with Clinical Parameters and Thermal Imaging Method in the Treatment of Hypercarbic Respiratory Failure Patient Group Presenting to the Emergency Department with Non-Life-Threatening COPD (Chronic Obstructive Pulmonary Disease Exacerbation)

Project no. 20933 · Status: Kapanmış (Yayın bekleniyor) · 2019

Summary

OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease that progresses with respiratory symptoms and airflow limitation, causing chronic inflammation of lung tissue, usually as a result of exposure to hazardous particles or gases. It is important for emergency physicians as it is a frequent reason for admission to the emergency department. Noninvasive Mechanical Ventilation and High Flow Nasal Oxygen are supportive respiratory devices that are frequently used in respiratory failure patient groups in emergency services. While many studies have shown that HFNO is successful in patients with Type 1 (hypoxic) respiratory failure, it has often been found in the literature that prospective studies are needed to determine whether it is as successful as NIMV in patients with Type 2 (hypercarbic) respiratory failure. In this study, it was aimed to prospectively compare the clinical efficacy of NIMV and HFNO applied in hypercarbic respiratory failure patients admitted to the emergency department with COPD exacerbation. Thermal imaging is a non-radiative, non-invasive method that is frequently used in medicine. While our study aims to apply NIMV and HFNO to COPD exacerbation patients and compare the treatment effectiveness with clinical parameters, device settings and blood gas data, on the other hand, by performing simultaneous thermal imaging, to determine the relationship of the thermal camera with the success of the treatment method, and thus to determine the use of the thermal camera in the emergency services. It aims to determine the suitability of a thermal camera in COPD exacerbation monitoring. MATERIALS AND METHOD: Our study was conducted prospectively between 2020-2022 with non-life-threatening type 2 respiratory failure patients diagnosed with COPD in the Emergency Service of Ege University Medical Faculty Hospital, after the approval of the Ege University Faculty of Medicine Ethics Committee.Patients with COPD exacerbation diagnosed with hypercarbic respiratory failure were evaluated by their physician in the routine operation of the emergency room, and at this stage, the physician's examination and treatment in the emergency service follow-up was not interfered with. Patients who met the diagnostic criteria of non-life-threatening respiratory failure, needed noninvasive mechanical ventilator despite the treatment administered by the physician (nebulizer bronchodilators, systemic corticosteroids, antibiotics, controlled oxygen therapy) and met the NIMV indications, were included in the study at the stage when the physician decided to start treatment. The physician's decision to start diagnosis, treatment and supportive respiratory therapy was not interfered with. The randomization of the patients was based on the order of arrival, and HFNO was applied to the patient group with odd numbers, and NIMV was applied to the patient group with even numbers. It was compared whether there was a significant difference in treatment success between the two supportive treatments.Our study is the first study in which thermal imaging method was used in the patient group who received NIMV in the emergency department.Our study is a multidisciplinary study and the images were analyzed by the Department of Electrical and Electronics Engineering of Ege University with the image processing software named "Meditherm Thermal Image Capture" and "Matlab". Our project was supported by The Office of Scientific Research Projects. RESULTS and CONCLUSION:1.    It has been determined that the thermal camera is an important non-invasive, radiation-free method that can be used to determine the success of treatment in the hypercarbic respiratory failure patient group. (back entropy and right skewness) However, there are limitations in the use of thermal camera in patients in the intensive care profile. For this reason, although it is more suitable to be used in the diagnosis and follow-up of stable patients, there is a need for multicenter, large population studies in this area.2.    In our study, it was concluded that HFNO was not as effective as NIMV in reducing carbon dioxide, according to the 60th minute data between the use of NIMV and HFNO in the group of patients with type 2 respiratory failure whom were diagnosed with COPD in the emergency department.3.    There was no significant difference between these two methods in terms of patient outcome, intubation, inotrope requirement, and near-term (48th hour) mortality.4.    It was concluded that HFNO is more successful than NIMV in terms of patient comfort.5.    We think that our prospective study with a larger patient population than its counterparts will make a significant contribution to the literature. KEYWORDS: COPD, Emergency Medicine, Thermal Imaging

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