Patients with ventilatory failure at discharge from hospital following an exacerbation of COPD (ECOPD) have increased work of breathing and reduced inspiratory muscle strength compared with those with a normal arterial carbon dioxide tension (PaCO(2)). They also have a significantly worse prognosis. Long-term non-invasive positive pressure ventilation (NIPPV) may offer a treatment strategy but benefits have not been established. ⋯ NIPPV was well tolerated in this group and appears to improve ventilation. Our preliminary data support further investigation of NIPPV in patients who remain hypercapnic after hospital admission with ECOPD.
Nicholas S Oscroft, Timothy G Quinnell, John M Shneerson, and Ian E Smith.
Respiratory Support and Sleep Centre, Papworth Hospital NHS Foundation Trust, Cambridge, UK. nickoscroft@doctors.org.uk
Respirology. 2010 Jul 1;15(5):818-22.
Background And ObjectivePatients with ventilatory failure at discharge from hospital following an exacerbation of COPD (ECOPD) have increased work of breathing and reduced inspiratory muscle strength compared with those with a normal arterial carbon dioxide tension (PaCO(2)). They also have a significantly worse prognosis. Long-term non-invasive positive pressure ventilation (NIPPV) may offer a treatment strategy but benefits have not been established.MethodsWe examined the outcomes of 35 patients, with a PaCO(2) >7.5 kPa and normal pH, following hospital admission with an ECOPD. Patients were initiated on long-term NIPPV. Our aims were to establish if NIPPV was tolerated and to describe the effects on ventilatory parameters.ResultsDaytime arterial blood gases and nocturnal ventilatory parameters improved significantly on NIPPV. Diurnal PaO(2), self-ventilating, rose from (mean (SD)) 7.3 (1.8) to 8.1 (0.9) kPa (P = 0.005) and PaCO(2) fell from 8.8 (1.3) to 7.3 (0.8) kPa (P ConclusionsNIPPV was well tolerated in this group and appears to improve ventilation. Our preliminary data support further investigation of NIPPV in patients who remain hypercapnic after hospital admission with ECOPD.