[Hypercapnic failure in patients with COPD under 4 weeks non-invasive, home mechanical ventilation]

In patients with severe COPD, ventilatory pump failure is a separate pathophysiological factor. Non-invasive ventilatory support has been introduced in COPD with acute-on-chronic respiratory failure according to evidence-based medicine, but the benefit of long-term ventilation is still not proven. The purpose of this investigation was to evaluate the feasibility of carbon dioxide-reducing, non-invasive, home mechanical ventilation in patients with chronic hypercapnic respiratory failure due to stable COPD.

In 40 patients (median age 72.2/61.1 - 78.1 years), with chronic ventilatory failure due to COPD who received non-invasive, home mechanical ventilation (NIV) successfully we analysed blood gases, lung function, 6-minute walking distance and quality of life before NPPV and after a period of at least 4 weeks of home therapy.

Successful home mechanical ventilation could be proven by a significant decrease of hypercapnia during spontaneous breathing: 8.5 kPa (64.6 mmHg) before NIV to 5.9 kPa (45.2 mm Hg) during NIV. Six-minute walking distance increased significantly from 89 m to 230 m. General health perception (SF 36) improved from 27 to 56 significantly as did other quality of life categories.

Although this investigation has some limitations such as lack of controls and highly selected patients, it could be proven that CO (2)-decreasing, non-invasive mechanical ventilation is feasible in terms of home therapy and effective to recompensate chronic ventilatory failure in stable COPD. Under such treatment, patients can reestablish their physical ability and report quality of life improvements.