Negative pressure ventilation versus conventional mechanical ventilation in the treatment of acute respiratory failure in COPD patients

Abstract

aaPatients with chronic pulmonary disease frequently need mechanical ventilatory support for acute exacerbation of the disease. In these patients, however, endotracheal intubation and mechanical ventilation lead to several complications including tracheal injury, barotrauma, nosocomial pneumonia, and weaning difficulty [1]. Complications and difficulty in weaning are the major factors in increasing the duration of hospitalization and for high costs, principally linked to the length of stay in very expensive facilities such as intensive care units (ICU).It has been shown that, in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF), noninvasive positive pressure ventilation (NIPPV) reduces the need for endotracheal intubation [2][3][4], the length of hospital stay [2,3] and the inhospital mortality rate [2][3][4][5], compared with standard therapy. The implementation of NIPPV at a much earlier stage in the course of respiratory failure than that at which intubation is normally considered could prevent the development of a severe acidosis, which has been found to be a poor prognostic feature for recovery [6]. The selection of patients is a crucial factor in the success of NIPPV [7] and this means that patients more severely ill than those included in previous studies [2-5] could not benefit from noninvasive mechanical ventilation; in these cases, conventional mechanical ventilation after intubation must be provided promptly. A recent study, however, has reported that COPD patients with severe respiratory acidosis and hypercapnic coma were successfully treated with a noninvasive ventilatory technique using negative pressure ventilation [8]. Direct comparisons between noninvasive and conventional mechanical ventilation in the treatment of COPD patients with ARF are scarce. In the only retrospective study, published recently by VITACCA et al. [9], the control These results suggest that negative pressure ventilation is as efficacious as conventional mechanical ventilation for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease and that it is associated with a shorter duration of ventilation and a similar length of hospital stay compared with conventional mechanical ventilation. Eur Respir J 1998; 12: 519-525.

Negative-pressure ventilation: is there still a role?

“…No complications were observed in Group A whereas four patients in Group B developed infective complications. These results suggest that NPV is as efficacious as IMV in the treatment of ARF in COPD patients and that it is associated with a shorter duration of ventilation and a similar length of hospital stay compared with IMV [9].…”

“…In 1998, CORRADO et al [9] published the first controlled study that formally compared NPV and conventional invasive mechanical ventilation (IMV) for the treatment of ARF in COPD patients. The aim of this retrospective case-controlled study was to evaluate the effectiveness of NPV versus IMV for the treatment of ARF in COPD patients admitted to an RICU and four general intensive care units (ICUs).…”

“…The primary end points of the study were in-hospital death for both groups and the need for endotracheal intubation in patients in Group A. The secondary end points were length and complications of mechanical ventilation and duration of hospital stay [9]. A total of 26 pairs were submitted for analysis.…”

“…In 1996, a comprehensive review examining the literature on this topic was published [1]. NPV does not have the same body of randomised controlled trial data to support its use in acute-on-chronic respiratory failure, but there have been seven uncontrolled studies [2][3][4][5][6][7][8] and two case controlled studies [9,10]. The studies have often been of large numbers of patients, and recently, the preliminary results of two randomised controlled trials comparing NPV with both invasive mechanical ventilation and mask ventilation have been reported in abstract form [11,12].…”

Iron lungversusconventional mechanical ventilation in acute exacerbation of COPD

“…A case-control study [9] suggested that ILV is as effective as IMV in the treatment of COPD patients with acute on chronic respiratory failure and is associated to a shorter duration of ventilation, and a similar length of hospital stay. Nevertheless, to date, no randomised study comparing ILV with IMV for the treatment of exacerbation of COPD has been carried out.…”