Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease

Barbé, Ferrán; Togores, Bernat; Rubí, Mateu; Pons, S; Maimo, A.; Agustí, Àlvar

doi:10.1183/09031936.96.09061240

Cited by 209 publications

(117 citation statements)

References 21 publications

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“…Firstly, indications for NIPPV still are ill defined, mostly in patients with mild and moderate acidosis who represent by far the majority of those admitted to a regular medical ward or to a Division of Respiratory Diseases. Indeed, at variance with the previously quoted authors, [4,5], BARBE Â et al [6] found that NIPPV administered for 6 h a day during the first 3 days of hospitalization does not facilitate recovery from ARF in such patients; likely, FOGLIO et al [7] demonstrated that NIPPV for 4 h a day for five consecutive days a week for 3 weeks does not have a better result than standard therapy alone. Furthermore, the effect of late treatment with NIPPV after an acute exacerbation in terms of patients' survival, need for further hospital admissions or need for invasive mechanical ventilation is not fully known, though CON-FALONIERI et al [8] demonstrated an improvement in the long-term outcome of a group of patients treated with NIPPV compared to a group of historically matched control patients treated conventionally.…”

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confidence: 51%

“…Patients with mild and moderate ARF are usually deemed to be at lower risk and, accordingly, are treated with medical therapy alone. Such physician behaviour has been reinforced by the recent demonstration by BARBE Á et al [6] that NIPPV does not improve early mortality and need for ET intubation in such patients. However, BARBE Á et al [6] did not follow their patients after hospital discharge, a period during which the current authors could demonstrate a better survival rate and a lower incidence of new hospital admissions.…”

Section: Discussionmentioning

confidence: 87%

“…Such physician behaviour has been reinforced by the recent demonstration by BARBE Á et al [6] that NIPPV does not improve early mortality and need for ET intubation in such patients. However, BARBE Á et al [6] did not follow their patients after hospital discharge, a period during which the current authors could demonstrate a better survival rate and a lower incidence of new hospital admissions. Moreover, CONNORS et al [9] demonstrated that the outcome of patients following exacerbation of COPD is generally poor and ANTHONISEN [3] showed that, even when medical therapy seems to work, the patients prognosis is unsatisfying.…”

Section: Discussionmentioning

confidence: 87%

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

Bardi¹,

Pierotello²,

Desideri³

et al. 2000

eur respir j

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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.

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confidence: 51%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 87%

See 1 more Smart Citation

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

Bardi¹,

Pierotello²,

Desideri³

et al. 2000

eur respir j

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“…The most relevant was a multicentre trial on COPD exacerbation that confirmed the efficacy of NIV in this setting (21 (22).…”

Section: Conventional Wardsmentioning

confidence: 99%

The art and science of non-invasive ventilation

Ferrer¹

2014

sob

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SummaryNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). NIV is considered a standard of care for the management of hypercapnic ARF in patients with acute exacerbation of chronic obstructive pulmonary disease. With an appropriate selection of patients, NIV can reduce the need for invasive mechanical ventilation, mortality and length of stay. Patients with severe hypoxemic ARF have in general a lower likelihood to need tracheal intubation when NIV as a support for ARF is added to the standard medical treatment. However, the effects of NIV on mortality are less evident, and the heterogeneity of the different published studies suggests that the efficacy may be different among different populations. The optimal time for intubation after NIV failure remains a challenging issue due to increasing evidences on the relationship between delayed intubation and excess mortality in these populations. In intubated patients with preexisting lung disease, the use of NIV in order to advance extubation during difficult and prolonged weaning can result in reduced periods of endotracheal intubation, complication rates and improved survival. Moreover, NIV immediately after extubation is effective in avoiding respiratory failure after extubation and improving survival in patients at risk for this complication, particularly those with chronic respiratory disorders, cardiac co-morbidity, and hypercapnic respiratory failure.KEY WORDS: non-invasive ventilation, acute respiratory failure, weaning, hypoxemic respiratory failure, hypercapnic respiratory failure. IntroductionNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). Non-invasive ventilation is ventilatory support through the upper airways of patients with an interface, usually a mask; therefore, tracheal intubation or a tracheostomy is not needed. The benefits of NIV appear to be the consequence of avoiding tracheal intubation and the associated morbidity and mortality (1, 2). There are several potential advantages for the use of NIV. Some patients can be managed out of an intensive care unit (ICU), a particularly stressful environment, with additional benefits in reducing the occupation of ICU beds and related costs. Ventilatory support can be intermittent and therefore withdrawal of NIV can be gradual. These patients can cooperate in respiratory therapy; they can receive nebulised therapy, expectorate and communicate with staff and their relatives. However, there are limitations for NIV. Unnecessary delay in intubation of those patients who fail with NIV treatment is associated with worse outcome (3). Some patients do not tolerate the mask due to claustrophobia or other causes, and nasal bridge skin breakdown can occur and difficult the use of NIV. Non-invasive ventilation is now considered as a firstline intervention in selected patients with severe exacerbation of chronic obstructive...

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“…Nevertheless, this method of ventilation requires the presence of nurses familiar with the technique, and this may be time-consuming [3,8]. Moreover, according to certain reports [2,4,9,10], some patients do not tolerate noninvasive ventilatory support, and side-effects of these techniques occur quite frequently [3,11].…”

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confidence: 99%

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

et al. 2000

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Methods of noninvasive pressure support ventilation (NIPSV) are not always easy to apply in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).The assistance time spent by nurses in relation to ventilatory time was prospectively studied, when NIPSV was used, in a sequential mode, in COPD patients with either acute exacerbations (58 patients, group I) or postextubation hypercapnic respiratory insufficiency (42 patients, group II) in a medical intensive care unit.During the first 24 h after enrolment, NIPSV was used for 6.7 3.2 h (mean SD) in group I and 5.6 3.1 h in group II; the duration of NIPSV sessions and the nurse time consumption per session were respectively 47 12 and 11 7 min in group I, and 46 12 and 11 6 min in group II. After the first 24 h of the study, the duration of NIPSV was 4.7 3.2 h . day -1 in group I and 4.9 3.5 h . day -1 in group II, and the nurse time consumption dropped significantly: the duration of NIPSV sessions and the nurse time consumption per session were respectively 44 10 and 7 4 min in group I, and 47 14 and 7 3 min in group II. Between the first 24 h and the subsequent period of 24 h, the nursing time dropped significantly (98 versus 59 min in group I (p<0.05), and 85 versus 52 min in group II (p<0.05)). There was no difference in the duration of NIPSV sessions, or in the overall assistance time per session, between the two groups of patients.In conclusion, the study seems to favour a quite low assistance time spent by nurses in relation to ventilatory time when noninvasive pressure support ventilation is used in chronic obstructive pulmonary disease patients with either acute exacerbations or postextubation hypercapnic respiratory insufficiency. Methods of noninvasive pressure support ventilation (NIPSV) are being proposed more and more for patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure [1±6]. NIPSV can avoid the need for endotracheal intubation and its increasingly documented complications [7]. Nevertheless, this method of ventilation requires the presence of nurses familiar with the technique, and this may be time-consuming [3,8]. Moreover, according to certain reports [2, 4, 9, 10], some patients do not tolerate noninvasive ventilatory support, and side-effects of these techniques occur quite frequently [3,11].Three articles have demonstrated that the institution of noninvasive mechanical ventilation is not significantly more time-consuming for personnel than traditional medical therapy [4,12] or invasive mechanical ventilation [13]. However, two of these studies [12,13] were performed in respiratory intensive care units (ICUs) with a specialized activity, and where patient/staff ratios are generally lower than in general ICUs [13]. The authors consider that the problem lies not in comparing the workload linked to utilization of NIPSV with that linked to standard treatment or invasive mechanical ventilation, since it is advisable to use NIPSV to avoid intubation. It is more a question of know...

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Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease

Cited by 209 publications

References 21 publications

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

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

The art and science of non-invasive ventilation

Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses

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