Prospective Comparative Evaluation of Noninvasive and Invasive Mechanical Ventilation in Patients of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure Type II.

INTRODUCTION: Acute respiratory failure is a potential complication of chronic obstructive pulmonary disease (COPD) that severely affects the health of the patient and may require mechanical ventilation. We compared noninvasive and invasive mechanical ventilation in COPD patients with acute respiratory failure type II to validate clinical outcome based on biochemical analysis of arterial blood gases (ABGs) and pulmonary parameters in terms of duration of mechanical ventilation, period spent in intensive care unit (ICU) and mortality. MATERIALS AND METHODS: After approval of institutional ethical committee 100 patients were selected for randomized prospective controlled trial and divided into two groups of 50 each according to mode of mechanical ventilation. Group-I patients managed with noninvasive ventilation (NIV) Group-ll managed with invasive ventilation. RESULTS: Demographic data between two groups were comparable. ABG parameters were better at 2 h and 6 h interval in NIV as compared to invasive ventilation (P < 0.05). The duration of ventilation and total time spent in ICU was 106±10 hours and 168±8 hours respectively in NIV group and 218 ± 12 and 280 ± 20 in invasive group. On intergroup comparison these were significantly less in noninvasive group (P < 0.05). Hospital acquired pneumonia occurred in 10% of patients in invasive group whereas no incidence of pneumonia found in noninvasive group. Mortality rate was 12% in invasive groups and 2% in noninvasive groups. CONCLUSION: NIV leads to significant improvement in ABG and pulmonary parameters and it reduces duration of ventilation and total period of hospital stay so it can be used as an alternative to invasive ventilation as first-line treatment in COPD.

Incidence of Postspinal Headache and Low Backache Following the Median and Paramedian Approaches in Spinal Anesthesia.

BACKGROUND AND AIMS: Postspinal headache and low backache are common complaints following spinal anesthesia which regresses spontaneously but sometimes becomes very troublesome for the patient as well as for the anesthesiologists. The aim of this study was to evaluate the incidence of postspinal headache and low backache after spinal anesthesia in lower abdominal surgery. MATERIALS AND METHODS: One hundred patients of 18-60 years of age group with patients physical status the American Society of Anesthesiologists Class I or II after due consent divided into equal numbers of two groups: median (M) approach and paramedian (P) approach scheduled for lower abdominal surgery. Group M (50 patients) received spinal by median approach while in Group P (50 patients) received spinal by paramedian approach. The incidence of postspinal headache and low backache was observed in each group. All the patients were observed up to 7 days postoperatively. Data collected was analyzed statistically by SPSS (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) and Chi-square test, and P < 0.05 considered as statistically significant. RESULTS: Postspinal headache was observed to be 4% in paramedian approach and 20% in median approach group. Backache incidence recorded in both the groups was 2% and 10%, respectively. P value calculated statistically was < 0.05 and hence statistically significant in paramedian approach in respect of incidence of both postspinal headache and backache. CONCLUSION: Incidence of postspinal headache and low backache is less in paramedian approach than in median approach.