Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1939
Peer-review started: February 8, 2020
First decision: March 18, 2020
Revised: April 4, 2020
Accepted: April 30, 2020
Article in press: April 30, 2020
Published online: May 26, 2020
Noninvasive ventilation (NIV) reduces intubation rates, mortalities, and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Helmet-based NIV is better tolerated than oronasal mask-based ventilation, and thus, allows NIV to be conducted for prolonged periods at higher pressures with minimal air leaks.
A 73-year-old man with a previous diagnosis of COPD stage 4 was admitted to our medical intensive care unit with chief complaints of cough, sputum, and dyspnea of several days’ duration. For 10 mo, he had been on oxygen at home by day and had used an oronasal mask-based NIV at night. At intensive care unit admission, he breathed using respiratory accessory muscles. Hypercapnia and signs of infection were detected, and infiltration was observed in the right lower lung field by chest radiography. Thus, we diagnosed AECOPD by community-acquired pneumonia. After admission, respiratory distress steadily deteriorated and invasive mechanical ventilation became necessary. However, the patient refused this option, and thus, we selected helmet-based NIV as a salvage treatment. After 3 d of helmet-based NIV, his consciousness level and hypercapnia recovered to his pre-hospitalization level.
Helmet-based NIV could be considered as a salvage treatment when AECOPD patients refuse invasive mechanical ventilation and oronasal mask-based NIV is ineffective.
Core tip: We present a case of acute exacerbation of chronic obstructive pulmonary disease in a 73-year-old male. Despite oronasal mask-based noninvasive ventilation (NIV) and adjustment of positive end-expiratory pressure and inspiratory positive pressures, hypercapnia and conscious level were not improved. The patient refused invasive mechanical ventilation, and accordingly we opted for helmet-based NIV. Subsequently, hypercapnia and conscious level recovered to his pre-hospitalization level. Helmet-based NIV may be considered as a salvage treatment, when an acute exacerbation of chronic obstructive pulmonary disease patient refuses invasive mechanical ventilation and has failed to respond to oronasal mask-based NIV.