Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency

Patients with chronic obstructive pulmonary disease (COPD) who have been intubated and mechanically ventilated may prove difficult to wean. Noninvasive ventilation may be used in an attempt to avoid new endotracheal intubation. The efficacy of administration of noninvasive pressure support ventilation was evaluated in 30 COPD patients with postextubation hypercapnic respiratory insufficiency, compared with 30 historically matched control patients who were treated conventionally. Patients were included in the study if, within 72 h postextubation, they presented with respiratory distress, defined as the combination of a respiratory frequency >25 breaths x min(-1), an increase in the arterial carbon dioxide tension (Pa,CO2) of at least 20% compared with the value measured after extubation, and a pH <7.35. Noninvasive pressure support ventilation was effective in correcting gas exchange abnormalities. The use of noninvasive ventilation significantly reduced the need for endotracheal intubation: 20 of the 30 patients (67%) in the control group required endotracheal intubation, compared with only six of the 30 patients (20%) in the noninvasive-ventilation group (p<0.001). In-hospital mortality was not significantly different between the two groups, but the mean duration of ventilatory assistance for the treatment of the postextubation distress, and the length of intensive care unit stay related to this event, were both significantly shortened by noninvasive ventilation (p<0.01). In conclusion, noninvasive ventilation may be used in the management of patients with chronic obstructive pulmonary disease and postextubation hypercapnic respiratory insufficiency.