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Among the limited studies in this area, the one reported by Tsuboi et al demonstrated BiPAP success rate in post TB sequelae comparable to acute exacerbation of COPD.7 AsoH et al also demonstrated effectiveness of NPPV in another study.14 They found lower PH, BMI and serum potassium associated with weaning failure.
In current study poor response was observed in non-respondents after 3 hours of initiating BiPAP therapy and there is further progressive decline in clinical parameters in this group of patients.
To the best of author's knowledge, this is the first study from South Asia that shows the potential factors that can predict the success of BiPAP in acute Type II failure in patients with Post Tb Sequelae.
In conclusion this study showed the successful treatment in patients with Type 2 respiratory failure post Tuberculosis sequelae in low resource countries with BiPAP. Appropriate selection of patients is paramount and continuous monitoring of patients and identification of clinical signs is essential.
To the best of our knowledge, apart from a small pilot study16 done in India, this is the only study reporting the use of BiPAP therapy through endotracheal tube in unconscious COPD patients.
Table-II: Comparison of ABG variables and GCS between responders and non-responders with BiPAP therapy.
In our study, we used a different method of administering BiPAP. Instead of using face mask, we used endotracheal tube as an interface between patient and the machine.
In resource poor settings, the use of BiPAP through endotracheal tube can be an effective and safe intervention for comatose COPD patients with hypercapnic respiratory failure.
The high cost associated with prolonged stay for assisted ventilation in intensive care may be spared by use of BiPAP, since it can be used at home or outside of the ICU.
BiPAP may be a more appropriate choice of ventilatory support for children with conditions, if they were intubated, where extubation may prove to be unlikely (Brochard, 1996).
There are several pediatric conditions in which BiPAP has potential use as a method of ventilation.
BiPAP has possible use in the child with central hypoventilation syndrome (CHS).