Outcomes of Bilevel Positive Airway Pressure And High Flow Nasal Cannula Oxygen In Patients with Acute Respiratory Distress Syndrome – A Prospective Observational Study

INTRODUCTION: Acute Respiratory Distress Syndrome (ARDS) carries significant mortality and morbidity. BiPAP and HFNC can offer an alternative to conventional systems of oxygenation when it not sufficient. The study was conducted with the aim to evaluate the clinical efficacy and safety of high flow nasal cannula oxygen and Bi-level positive airway pressure in patients with Acute Respiratory Distress Syndrome (ARDS). And compare results of invasive ventilator free period; length of ICU stay in both groups and associated morbidity and mortality in ventilated patients. OBJECTIVES: To evaluate the efficacy of high flow nasal cannula oxygen and Bi-level positive airway pressure in patients with Acute Respiratory Distress Syndrome. MATERIALS AND METHODS: We conducted a prospective observational study in our ICU. A total of 60 patients were enrolled, 30 in each HFNC and BiPAP as per the treating physician. Patient's demographic data, APACHE II, MC CABE and SOFA scores were recorded. Clinical parameters, blood gas parameters, comfort score, duration of the either of therapy and length of ICU stay were all recorded. Number of patients who were invasively ventilated and associated mortality and morbidity was recorded. RESULTS: The demographic characteristics of the patients at enrollment were similar. The mean APACHE II score, MC CABE Score were not significant. The most common etiology Of ARDS studied in both the groups was COVID 19 infection, compromising about 47(78.3%) of the total patients. PaO2 levels were significantly better in BiPAP Group (P = 0.002), the Mean respiratory rate in HFNC group was much lower (P = 0.074) and Comfort score was better in HFNC group (P = 0.007). The total duration of days spent on HFNC and BiPAP therapy and the total length of duration in ICU was not significant (P = 0.601). Out of the total 60 patients, 17(28.3%) were intubated, 11(36.7%) in BiPAP group and 6(20%) in HFNC group (P = 0.251). About 13(21.7%) of the study sample died, 5(16.7%) in HFNC and 8(26.7%) in BiPAP Group. DISCUSSIONS/CONCLUSIONS: In patients with ARDS, treatment with HFNC, or BiPAP did not result in significantly different duration of therapy, length of ICU stay, intubation and mortality rates. There was a significant difference in favour of HFNC in terms of Dyspnoea Comfort Score, and reduced respiratory rate and there was no difference in PaCO2 levels in both groups. But BiPAP group had significant better Oxygenation (PaO2 Levels).