Nocturnal Nasal Ventilation for Treatment of Patients With Hypercapnic Respiratory Failure

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We reviewed the Mayo Clinic experience with nocturnal nasal ventilation (NNV) and retrospectively assessed the clinical benefits, patient compliance, and complications. NNV had been instituted in 26 patients with daytime hypercapnia and nocturnal hypoventilation due to neuromuscular diseases or chronic obstructive pulmonary disease. After initiation of NNV, 21 of 26 patients continued to use this treatment regularly (81% compliance rate) and considered their life-style improved. In this subset of patients, the arterial partial pressure of carbon dioxide during unassisted breathing decreased from 64 ± 13 to 51 ± 7 mm Hg, and the arterial partial pressure of oxygen increased from 58 ± 12 to 68 ± 8 mm Hg. No significant change was noted in the forced vital capacity or maximal respiratory pressures. Four of the five patients in whom NNV had been discontinued cited discomfort related to the mask or severity and poor prognosis of the underlying illness as reasons for cessation of treatment. We conclude that NNV is well tolerated by most patients and may improve alveolar ventilation and arterial oxygenation in patients with chronic respiratory failure.

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Patient Population and Selection Criteria.

Both ambulatory and hospitalized patients with hypercapnic ventilatory failure (arterial partial pressure of carbon dioxide [PaCO2] of more than 45 mm Hg) and nocturnal oxygen desaturation were considered for this protocol. All patients had undergone polysomnography or overnight pulse oximetry monitoring and demonstrated recurrent nocturnal hypoxemia refractory to supplemental oxygen therapy or alternative types of ventilatory support (or both). We excluded patients who required intubation for

Characterization of Study Group.

The 22 male and 4 female patients had a mean age of 58.4 (range, 17 to 76) years (Table 1). Unsuccessful treatment attempts before NNV included nasally administered continuous positive airway pressure in 11 patients, supplemental oxygen alone without augmented ventilation in 10, negative pressure ventilation with a cuirass in 2, and pharmacotherapy (medroxyprogesterone acetate) in 1. One patient with nocturnal hypoventilation syndrome had received conventional mechanical ventilation through a

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