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Long-term non-invasive ventilation to manage persistent ventilatory failure after COPD exacerbation
Nicholas S Oscroft1, Timothy G Quinnell, John M Shneerson
1Respiratory Support and Sleep Centre, Papworth Hospital NHS Foundation Trust, Cambridge, UK. nickoscroft@doctors.org.uk
Respirology (Carlton, Vic.)
|June 16, 2010
Summary
Long-term non-invasive positive pressure ventilation (NIPPV) improved ventilation in patients with chronic obstructive pulmonary disease (COPD) exacerbation. This treatment was well-tolerated and showed promising results for patients with persistent hypercapnia.
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
Background:
- Patients experiencing ventilatory failure after a COPD exacerbation have impaired breathing and worse prognosis.
- Long-term non-invasive positive pressure ventilation (NIPPV) is a potential treatment, but its benefits are not yet established.
Purpose of the Study:
- To assess the tolerance and effects of long-term NIPPV on ventilatory parameters in patients with COPD exacerbation and hypercapnia.
- To evaluate NIPPV's impact on gas exchange and patient outcomes.
Main Methods:
- A study of 35 patients with COPD exacerbation and hypercapnia (PaCO(2) >7.5 kPa, normal pH) initiated on long-term NIPPV.
- Assessment of daytime arterial blood gases and nocturnal ventilatory parameters before and during NIPPV treatment.
Main Results:
- NIPPV significantly improved daytime oxygen and reduced carbon dioxide levels, alongside improved nocturnal oxygen saturation and reduced transcutaneous carbon dioxide.
- Improvements were observed in both patients recovering from exacerbation and a stable COPD group, suggesting NIPPV efficacy beyond recovery.
- High patient acceptance (89%) and compliance (8.4 hours/day) with NIPPV were noted, with a median survival of 28.6 months.
Conclusions:
- Long-term NIPPV is well-tolerated and effectively improves ventilation in hypercapnic COPD patients post-exacerbation.
- Preliminary findings support further investigation of NIPPV for this patient group.
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