Die nichtinvasive Beatmung bei Patienten mit stabiler, schwergradiger chronisch-obstruktiver Bronchitis und Lungenemphysem (COPD)

Abstract

Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use.

Efficacy of long-term noninvasive positive pressure ventilation in stable hypercapnic COPD patients with respiratory failure: a meta-analysis of randomized controlled trials

“…Therefore, some scholars believed that NPPV could benefit the patients with stable hypercapnic COPD by reducing the burden of respiratory muscle, relieving the fatigue and improving the gas exchange. 34 , 35 However, most of the previous RCTs could not reduce PaCO 2 significantly probably due to the low intermittent positive airway pressure (IPAP) of 10–20 cmH 2 O in NPPV. Current studies showed that IPAP in NPPV reaching 30 cmH 2 O could obviously improve the level of arterial blood gas in patients with stable hypercapnic COPD.…”

“…Current studies showed that IPAP in NPPV reaching 30 cmH 2 O could obviously improve the level of arterial blood gas in patients with stable hypercapnic COPD. 6 , 35 , 36 A long-term study carried out by Windisch et al 6 showed that NPPV targeted at greatly reducing hypercapnia (average IPAP =28 cmH 2 O) could significantly improve the levels of arterial blood gas and lung function of COPD patients with chronic respiratory failure and reduce the mortality to 86% in 2 years. Consistent with the abovementioned opinion, we found that high IPAP settings benefited patients more.…”

Komplexe Differenzialdiagnostik - Erstdiagnostik und Therapie der Dyspnoe aus Sicht des Pneumologen

“…Indiziert ist eine solche Heimbeatmung bei einer symptomatischen Hyperkapnie mit einem Kohlendioxidpartialdruck über 55 mmHg, in Ausnahmefällen ist eine solche Behandlung bereits bei Werten über 50 mmHg indiziert (31). Empfehlenswert ist eine nächtliche Beatmung, damit tagsüber möglichst viel beatmungsfreie Zeit verfügbar ist (11).…”