Comparison Rate of Hospitalization between Noninvasive Ventilator and Standard Medical Therapy in Acute Asthmatic Attack in Emergency Department, Bhumibol Adulyadej Hospital, RTAF
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Abstract
Background : Noninvasive ventilation (NIV) has a greater role in the management of patients with acute respiratory failure recently, especially in management of exacerbation of chronic obstructive airway disease which has pathophysiology similar to asthma. However, its efficacy in treating patient with acute asthmatic attack is not well defined.
Objective : The purpose of this study was to compare the rate of hospitalization between applying NIV to standard medical therapy and standard medical therapy alone in the patients with acute asthmatic attack.
Material and methods : The patients were randomized to receive standard medical therapy combines with NIV or standard medical therapy alone. The primary outcome was the rate of hospitalization. The secondary outcomes were the rate of intubation, duration of hospitalization, doses of bronchodilator and the
percentage of change of the peak flow. The inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) started at 10 cmH2O and 5 cmH2O. The IPAP was titrated by 2 cmH2O each time (max = 20 cmH2O)
Results : 61 patients who presented with acute asthmatic attack were divided in 2 groups. 30 patients were randomly assigned to NIV plus standard medical therapy and 31 patients to standard medical therapy alone. The intubation rate (control = 0 %, NIV = 0 % p=NA) was not significantly different between two groups). NIV can decreased hospitalization rate (control = 48.4 %, NIV = 30 % p=0.142) but not significantly.
There was significant improvement in pulmonary function in the group using NIV than another group.
The duration of hospitalization (control = 46.817.2 hours, NIV =37.912.4 hours p=0.024) and doses of
bronchodilator (control = 31.213.6 times, NIV = 25.18.8 times p=0.044) were significantly decrease in the NIV group.
Conclusion : The applying of NIV to standard medical therapy can decrease rate of hospitalization but not significantly. NIV significantly shortened the duration of hospitalization, decreased doses of bronchodilator and improved pulmonary function. These can be the solution for overcrowding problem in hospital
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References
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