Background -Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The Non-invasive mechanical ventilation is increasingly being used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). To date, controlled studies comparing non-invasive mechanical ventilation with endotracheal intubation are lacking, so the use of non-invasive mechanical ventilation as an alternative to intubation might, if unsuccessful, unduly delay endotracheal intubation.l The aim of this study was to identify simple measures which could be used to predict whether patients with COPD could be successfully treated with noninvasive mechanical ventilation, and also to avoid unnecessary delay in intubation of those who deteriorate on non-invasive mechanical ventilation. MethodsWe retrospectively reviewed the data of 47 patients with COPD (31 men) undergoing 59 consecutive episodes of acute respiratory failure. All were chronically hypoxaemic and hypercapnic and on long term oxygen therapy. Patients with relevant concomitant diseases were excluded. All had undergone acute relapses of their primary disease and had been given non-invasive mechanical ventilation and met the following criteria: rapid deterioration in neurological status,5 acute onset of severe hypercapnia (Paco2 >8-5 kPa), acute decrease in pH (<7 35), tachypnoea and/or abdominal paradox. The attending physicians considered that all these patients were likely to require mechanical ventilation and performed a short (1-2 hours) trial of non-invasive mechanical ventilation before endotracheal intubation when, according to their own clinical judgement, the clinical and functional status deteriorated despite non-invasive mechanical ventilation.Mechanical ventilation was added to standard medical and oxygen therapy. Modalities of non-invasive mechanical ventilation were either pressure support ventilation (NPSV) (25 episodes) or intermittent positive pressure ventilation (NIPPV) in assisted/controlled mode (34 episodes) delivered through either nasal or facial masks. The ventilatory settings were as previously described.3 The following data were considered from the case records:
The aim of this study was to evaluate the long-term outcome of an outpatient pulmonary rehabilitation programme (PRP) in patients with chronic airway obstruction (CAO).In 61 CAO patients (35 asthmatics and 26 chronic obstructive pulmonary disease (COPD)) lung and respiratory muscle function, exercise tolerance (by symptom limited cycloergometer and walking tests), dyspnoea (Borg scale, visual analogue scale (VAS), baseline and transitional dyspnoea index (BDI and TDI, respectively)) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were assessed at baseline (t0), at discharge (t1) and 12 months postdischarge (t2). Preprogramme and postprogramme hospital admissions and exacerbations of disease were also recorded.In comparison with baseline, no significant change was observed in lung function tests in either diagnostic group, either at t1 or at t2. In both groups improvements in respiratory muscle strength, exercise tolerance, Borg scale and VAS reported at t1 were partially reduced at t2. Analysis of variance showed that these changes over time were similar in the two groups. Mean values of SGRQ and BDI/TDI improved at t1, and, unlike exercise tolerance, did not worsen at t2. However, a clinically relevant difference in SGRQ between t2 and t0 was reported only in 56% of asthmatics and 52% of COPD patients. Compared with the preceding 2 yrs, in the year following PRP, hospital admissions and disease exacerbations decreased significantly in both diagnostic groups.Regardless of diagnosis, patients with chronic airway obstruction who underwent an outpatient pulmonary rehabilitation programme maintained an improved quality of life 12 months postdischarge despite a partial loss of the improvement in exercise tolerance. Eur Respir J 1999; 13: 125±132.
This study investigates the impact of proportional assist ventilation (PAV), a new mode of partial ventilatory support, on exercise tolerance and breathlessness in severe hypercapnic chronic obstructive pulmonary disease (COPD) patients. We also examined the effects of continuous positive airway pressure (CPAP) and pressure support ventilation (PSV). On two consecutive days, 15 stable hypercapnic COPD patients underwent four endurance tests on a cycle ergometer at 80% of their maximal workrate, receiving, via a nasal mask in random order, either: 1) sham ventilation (CPAP: 1 cmH2O); 2) CPAP (6 cmH2O); 3) PSV (inspiratory pressure support: 12-16 cmH2O; expiratory positive airway pressure (EPAP): 1 cmH2O); or 4) PAV (8.6+/-3.6 cmH2O x L(-1) and 3+/-1.3 cmH2O x L(-1)x s(-1) of volume and flow assistance, respectively plus EPAP: 1 cmH2O). Oxygen supply was standardized to maintain an arterial oxygen saturation (Sa,O2) of 92-93%. Breathing pattern and minute ventilation (by respiratory inductive plethysmography), pulse oximetry, end tidal partial pressure of CO2, cardiac frequency and sensations of dyspnoea and leg discomfort (by Borg scale) were monitored. In comparison to sham ventilation, PAV, PSV and CPAP were able to increase the endurance time (from 7.2+/-4.4 to 12+/-5.6, 10+/-5.2 and 9.6+/-4.6 min, respectively) and to reduce dyspnoea and oxygen flow to the nasal mask. However, the greatest improvement was observed with PAV. We conclude that PAV delivered by nasal mask can im-prove exercise tolerance and dyspnoea in stable hypercapnic COPD patients and hence this mode of ventilatory support may be useful in respiratory rehabilitation programmes.
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