Noninvasive mechanical ventilation with BiPAP therapy for comatose exacerbation of chronic obstructive pulmonary disease through an endotracheal tube: is it justified?

Noninvasive mechanical ventilation with BiPAP therapy for comatose exacerbation of chronic obstructive pulmonary disease through an endotracheal tube: is it justified? Letter (1156) Total Article Views Authors: Esquinas A, Agarwal R Published Date December 2012 Volume 2012:7 Pages 807 - 809 DOI: http://dx.doi.org/10.2147/COPD.S38179 Received: 15 September 2012 Accepted: 28 October 2012 Published: 03 December 2012 Antonio Esquinas,1 Ritesh Agarwal2 1Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain; 2Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India We read with interest the paper by Rawat et al1 related to the role of bilevel positive airway pressure (BiPAP) delivered via endotracheal tube in unconscious patients suffering from acute exacerbations of chronic obstructive pulmonary disease in a real-world situation. Although the authors provide some justification for the use of BiPAP through an endotracheal tube, we believe that this technique is fraught with complications and should not be routinely employed. In fact, three patients failed BiPAP therapy, two patients received conventional invasive ventilation, and one patient failed to respond to BiPAP. Thus, almost 30% of patients either failed or showed no evidence for benefit of BiPAP. Further, the authors provide no data on the amount of leakage that was present while administering BiPAP therapy. The authors also do not provide details on whether the nurses/chest therapist administered intermittent manual bag ventilation. Ideally, the authors should have referred the patients on manual bag ventilation to another public health center where facilities for invasive ventilation are available free of cost. View original paper by Rawat and colleagues. Post to: Cannotea Citeulike Del.icio.us Facebook LinkedIn Twitter Readers of this article also read: Radiolucency below the crown of mandibular horizontal incompletely impacted third molars and acute inflammation in men with diabetes Exacerbation rate, health status and mortality in COPD – a review of potential interventions Berberine: metabolic and cardiovascular effects in preclinical and clinical trials Subset-directed antiviral treatment of 142 herpesvirus patients with chronic fatigue syndrome Deep vein thrombosis: a clinical review Comparison of two treatments for coxarthrosis: local hyperthermia versus radio electric asymmetrical brain stimulation Role of BiPAP applied through endotracheal tube in unconscious patients suffering from acute exacerbation of COPD: a pilot study GOLD and the fixed ratio Dexmedetomidine sedation in painful posterior segment surgery Chronic obstructive pulmonary disease as a cardiovascular risk factor: results of a case-control study (CONSISTE study)