Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long term follow up and effect on survival

Abstract

Background-There is increasing interest in the use of non-invasive nocturnal intermittent positive pressure ventilation (NIPPV) in the management of patients with chronic hypercapnoeic (type II) respiratory failure. Although this treatment enables patients requiring mechanical ventilatory support to be treated more readily at home, few studies have been done to demonstrate its long term benefits in chronic obstructive pulmonary disease (COPD) and the application of NIPPV in these circumstances remains controversial. Methods-Eleven patients in severe stable chronic type II respiratory failure due to COPD who were unresponsive to conventional treatments experienced symptomatic hypercapnia when receiving suYcient supplementary oxygen to result in an arterial oxygen saturation (SaO 2 ) of >90%. They were assessed for treatment with NIPPV, and its eVects were observed for over two years using arterial blood gas tensions, spirometric parameters and body mass index (BMI), survival, hospital admissions, use of general practitioner resources, and patient satisfaction. Results-Hospital admissions and GP consultations were halved after one year compared with the year before NIPPV and there was a sustained improvement in arterial blood gas tensions at 12 and 24 months when breathing air, despite progressive deterioration in ventilatory function. BMI did not change during the period of observation. The median survival was 920 days, with no patient dying within the first 500 days. Conclusions-Domiciliary NIPPV results in improvements in arterial blood gas tensions which are sustained after two years of treatment and reduces both hospital admissions and general practitioner visits by patients with severe COPD in hypercapnoeic respiratory failure. It is well tolerated and, although there was no control group, survival appears to be prolonged when these results are compared with those of the NOTT and MRC (LTOT) trials. (Thorax 1998;53:495-498) Keywords: home ventilation; chronic obstructive pulmonary disease; outcome measures Non-invasive positive pressure ventilation (NIPPV) is a well established form of treatment for chronic hypercapnoeic (type II) respiratory failure in patients with neuromuscular disease or skeletal deformity. Although there has been increasing interest in its use for patients in chronic type II respiratory failure due to chronic obstructive pulmonary disease (COPD), its use remains controversial in this group of patients with conflicting reports of its eYcacy and acceptability. MethodsEleven patients, all ex-smokers in severe type II respiratory failure, were electively admitted between 1991 and 1995. All were diagnosed as having COPD and were receiving maximal drug therapy. Long term oxygen therapy (LTOT) suYcient to correct hypoxaemia (SaO 2 >90%) resulted in symptomatic hypercapnia, especially morning headaches and excessive diurnal somnolence. Sleep apnoea syndrome was excluded (apnoea/hypnoea index <10) but patients 1, 3, 7, 8, 9, and 10 (table 1) experienced severe sleep hypoventilation....

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

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk There were three small prospective uncontrolled observational studies, two 106,107 in stable populations (n = 11 and n = 35) and one 108 in a post-hospital population (n = 27) (see Appendix 8 for further details). The study in a post-hospital population did not report before and after (NIV) data and so did not add useful information.…”

Chronic Obstructive Pulmonary Disease and Sleep

“…İleri evre KOAH ve hiperkapnisi olan küçük bir grupta yapılan kontrolsüz bir çalışmada, evde NPPV kullanımının oksijenizasyonu iyileştirdiği ve hastaneye başvuruları azalttığı görülmüştür. 69 Kontrollü bir çalışmada, NPPV inspiratuar destek modunda ileri evre, hiperkapnik stabil KOAH hastalarında gaz değişiminde iyileşme yapmadan, uyku etkinliğinde ve toplam uyku süre-sinde iyileşme sağlamaktadır. Stabil KOAH'lı hastalarda noktürnal NPPV'nin kullanı-mı ile ilgili bir metaanalizde, üç ay boyunca uygulanan ventilatör destekte akciğer fonksiyonlarında, gaz değişiminde ve uyku etkinliğinde iyileşme olmadığı gösterilmiştir.…”

Noninvasive Positive-Pressure Ventilation Therapy in Patients with COPD

“…The reported studies show some physiological benefits for the use of NPPV in stable COPD, but clear survival benefit has not yet been demonstrated (Leger et al 1994;Jones et al 1998;Tuggey, Plant, & Elliott 2003). All of these and most other studies used a moderately aggressive ventilation to treat stable hypercapnic COPD patients and so an impressive reduction in hypercapnia was not achieved.…”