Comparison between nocturnal nasal positive pressure ventilation combined with oxygen therapy and oxygen monotherapy in patients with severe COPD.

Abstract

We evaluated the benefits of O2 therapy and nocturnal nasal positive pressure ventilation (NPPV) with or without O2 in patients with severe chronic obstructive pulmonary disease (COPD). Twelve patients with severe COPD and nocturnal oxygen desaturation, who had not been receiving long-term O2 therapy and who could tolerate more than 2 wk of NPPV therapy, were enrolled in this study in a stable condition. Data on pulmonary function tests (PFTS), arterial blood gases (ABG), right and left ventricular ejection fractions (RVEF and LVEF) from nuclear medicine studies, and overnight sleep studies were collected at the beginning of the study and after each 2 wk of therapy with O2, NPPV, or NPPV with O2. Patients received O2 monotherapy or NPPV for sequential 2-wk periods in a randomized, cross-over design, followed by 2 wk of NPPV with O2. Hypoxic and hypercapnic ventilatory responses (HVR) in the study group, as measured by mouth occlusion pressure in the first 100 ms of inspiration against an occluded airway (P0.1), were compared with normal controls and repeated after 2 wk of therapy with NPPV with O2. The results revealed no significant changes in the percent of each sleep stage regardless of the treatment modality. However, sleep efficiency was poorer when NPPV was used than when it was not used. NPPV alone did not improve nocturnal oxygenation when compared with the baseline sleep study. Oxygen monotherapy was better than NPPV therapy for improving nocturnal oxygenation. NPPV plus O2 therapy showed no benefits over O2 monotherapy in either RVEF or LVEF, ABG, or HVR. In conclusion, for severe COPD patients, O2 therapy is more effective than NPPV for improving nocturnal oxygenation.

Home ventilation

“…This result should be contrasted with the finding that, in a short-term study, sleep quality after 2 weeks of NIV was worse than that with oxygen therapy [52].…”

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

“…While there is no widely accepted definition of low-pressure and high-pressure NIV, there has been work to suggest that degree of IPAP may relate to outcome, and there has been an increasing trend towards the use of higher pressures in more recent studies 32,33 compared with older studies. 34,35 The type of NIV most useful to COPD is not clear; neither are the optimal pressure setting and optimisation protocol. It is likely that there will be significant patient variability and individualised protocols will be required.…”

Noninvasive ventilation in chronic ventilatory failure due to chronic obstructive pulmonary disease

“…There have been few controlled trials, those of which used small numbers of patients followed over a short period of time [17][18][19][20]. Only one study showed any benefit from the combination of NPPV and long-term oxygen therapy (LTOT) [19], with the others failing to show any advantage to using NPPV.…”