Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Abstract

The use of noninvasive ventilation in pulmonary disease has been shown to improve the blood gases of pati-ents both while awake [1][2][3] and asleep [1,4,5] but it has proved difficult to identify in which patients survival or quality of life can be improved [5][6][7]. Mask intermittent positive pressure ventilation (MIPPV) has been introduced in acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) as a short-term measure to reduce intubation rates and improve survival [8].Long-term oxygen therapy (LTOT) improves survival in chronically hypoxic COPD patients [9,10]; however, patients with a high arterial carbon dioxide tension (Pa,CO 2 ) had a poor prognosis both prior to oxygen therapy [11,12] and (at least in the first year) with oxygen therapy [13]. In some patients, hypercapnia deteriorates with oxygen therapy manifesting with headaches, confusion, drowsiness and difficulty concentrating such that LTOT is not tolerated. Long-term MIPPV could in principle prevent this complication and improve survival.We report our experience with nocturnal mask ventilation in patients with COPD with hypercapnic respiratory failure in whom oxygen therapy resulted in worsening daytime or nocturnal hypercapnia. Materials and methods Patient selectionThe inclusion criteria were: 1) arterial oxygen tension (Pa,O 2 ) <7.3 kPa and Pa,CO 2 >6.0 kPa while breathing room air; 2) stable clinical state, arterial blood gases and pulmonary function tests over the 3 weeks prior to the study (with a daytime arterial H + concentration between 35-48 nmol -1 ); and 3) supplementary oxygen therapy failed either to raise the daytime Pa,O 2 to >7.3 kPa without a rise in the awake Pa,CO 2 to >8 kPa or failed to raise nocturnal oxygen saturations to >90% without a rise in the transcutaneous carbon dioxide tension (Ptc,CO 2 ) to >9 kPa. Patients with co-existing pulmonary diseases, neuromuscular or chest wall disorders were excluded. Twenty six patients, 13 males and 13 females, fulfilling these criteria were studied retrospectively. Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease. P. Sivasothy, I.E. Smith, J.M. Shneerson. ERS Journals Ltd 1998.ABSTRACT: Noninvasive ventilation in chronic obstructive pulmonary disease (COPD) has been shown to improve arterial blood gases but its long-term role has not been established.We retrospectively studied 26 consecutive patients with hypercapnic ventilatory failure due to COPD in whom oxygen therapy caused worsening hypercapnia (defined as a rise in the daytime arterial carbon dioxide tension (Pa,CO 2 ) to >8.0 kPa or nocturnal transcutaneous carbon dioxide tension (Ptc,CO 2 ) to >9 kPa). All were treated with mask ventilation (15 with nasal and 11 face masks) at night and during daytime naps. Additional oxygen therapy was required in 15 patients.The mean annualized death rate was 10.8% with a 1 and 3 yr survival of 92 and 68%, respectively. After 1 yr the median daytime Pa,CO 2 had falle...

Nonpharmacological treatment and relief of symptoms in COPD: Table 1—

“…The association between underweight and mortality in COPD patients remains significant after adjusting for possible confounders, such as FEV1 [115]. This observation is common to chronically ventilated hypercapnic COPD patients with a body mass index of ,20 kg?m -2 [116]. In particular, muscle wasting and depletion is a common problem in COPD patients [117], and it is mainly caused by an imbalance between low-energy intake and highenergy requirements [118].…”

Validation of the English Severe Respiratory Insufficiency Questionnaire

“…Studies by ELLIOTT et al [29] and SIVASOTHY et al [30] did not show significant change in HRQL. However, MEECHAM JONES et al [26] and PERRIN et al [31] showed significant HRQL improvement.…”

An overnight comparison of two ventilators used in the treatment of chronic respiratory failure

“…The outcome of regular NIPPV in obstructive lung disease has improved in recent years, but remains less favourable [1,5]. NIPPV improves outcome in acute respiratory failure [19,20] and acute exacerbations of chronic obstructive pulmonary disease [21,22].…”

“…Regular nocturnal treatment improves overnight oxygen saturation and daytime arterial blood gases in obstructive and restrictive pulmonary disorders [1,2]. There are beneficial effects on sleep duration and efficiency and improvements in quality of life [3,4].…”