Nasal ventilation in COPD exacerbations: early and late results of a prospective, controlled study

Abstract

Noninvasive positive pressure mechanical ventilation (NIPPV) in exacerbated chronic obstructive pulmonary disease (COPD) has been investigated early and after 1 yr of follow-up.To this end, 30 patients were enrolled in a prospective, controlled trial: 15 had early administration of NIPPV (Group A), 15 had medical therapy only (Group B); assignment was made on the basis of equipment availability only.In-hospital mortality, need for endotracheal intubation and mean length of hospitalization were lower in Group A, though the difference was not statistically significant. Arterial oxygen tension in arterial blood (Pa,O 2 ), carbon dioxide tension in arterial blood (Pa,CO 2 ) and HCO 3 -improved significantly in both groups from admission to discharge: 45. -up, 3, 6, and 12 months survival rates were significantly higher in Group A than in Group B (p<0.02). Hospital new admissions over 1 yr were more frequent in Group B (n=6, incidence rate: 0.216%) than in Group A (n=4, incidence rate: 0.084%).Therefore, noninvasive positive pressure mechanical ventilation may be added to "conventional" medical therapy in exacerbated chronic obstructive pulmonary disease. Eur Respir J 2000; 15: 98±104.

Mechanical ventilation: invasive versus noninvasive

“…Three studies have suggested that the use of NIV is associated with a better 1-yr survival compared to standard ICU therapy [33,34] or invasive mechanical ventilation [35]. The recent study of CONTI et al [21] confirms these findings.…”

Noninvasive ventilation for acute respiratory failure

“…BARDI et al [8] found no significant differences in hospital outcome between NIV and conventional therapy in a study of 30 patients with COPD, with the majority of patients in both groups recovering without the need for invasive ventilation. Because there was no ICU on site NIV was started early, and as the mean pH in the two groups were 7.36 and 7.39 and no patient in either group had a pH v7.30 these results are not surprising.…”

Noninvasive Positive-Pressure Ventilation Therapy in Patients with COPD

“…In more severely ill patients (pH<7.25), the rate of NPPV failure was inversely related to the severity of respiratory acidosis, rising up to 52%-62% (Conti et al 2002;Squadrone et al 2004). In patients with ''mild'' exacerbations, not complicated by respiratory acidosis, the use of NPPV was investigated in few studies, including patients in large majority with pH>7.35, which failed to demonstrate a better effectiveness of NPPV than standard medical therapy in preventing the occurrence of ARF (Bardi et al 2000;Keenan, Powers, & McCormack 2005). Guidelines recommend the use of NPPV in addition to usual care in patients who have a severe exacerbation of COPD (pH<7.35 and relative hypercarbia) (grade 1A recommendation) (Keenan et al 2011).…”