Chest
Volume 103, Issue 1, January 1993, Pages 266-268
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Preliminary Report
Continuous Positive Airway Pressure in COPD Patients in Acute Hypercapnic Respiratory Failure

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We used mask continuous positive airway pressure (CPAP) in seven patients with acute hypercapnic respiratory failure in an attempt to avoid endotracheal intubation and mechanical ventilation. Mask CPAP was started at 5 cm H2O and then increased to a maximum of 10 cm H2O depending on the clinical response. In five patients, CPAP significantly improved gas exchange; four of these patients were weaned to oxygen by face mask without needing intubation. In two patients, gas exchange deteriorated even with CPAP of 10 cm H2O. No barotrauma or adverse hemodynamic effects were associated with CPAP. We conclude that a trial of mask CPAP may be warranted before intubation of an alert, acutely hypercapnic patient with COPD.

Section snippets

Patient Selection

The subjects were patients admitted to the intensive care unit (ICU) with an acute exacerbation of COPD refractory to conventional treatment with bronchodilators and systemic corticosteroids.

Demographic information and baseline pulmonary function data are summarized in Table 1. Patients were offered a trial of mask CPAP if they were alert, responsive, and hemodynamically stable and met the following criteria: (1) persistent or deteriorating acute respiratory acidosis despite maximal medical

RESULTS

Seven patients aged 58 to 79 years were selected for study. Five of these patients responded to CPAP, and the other two patients failed to respond. Arterial Pco2 and pH in individual patients before and after CPAP are summarized in Figure 1. CPAP therapy lasted an average of 9.4 h (range, 2 to 24 h). No barotrauma or adverse hemodynamic effects occurred (Table 2). Four of the five responders were eventually weaned to oxygen by face mask after an average of 9 h (range, 5 to 11 h) of mask CPAP

DISCUSSION

Our study indicates that a trial of mask CPAP can be safely administered to patients with acute hypercapnic respiratory failure resulting from an exacerbation of COPD. Most patients who received masked CPAP had sufficiently improved clinical status and arterial blood gas values to avoid intubation and mechanical ventilation during the study period.

Various mechanisms may mediate the benefits of CPAP in airflow-limiting diseases. Gay et al5 have postulated that the positive inspiratory pressure

ACKNOWLEDGMENTS

The authors would like to thank Michael R. Pinsky, M.D., for his support of this project and his critical review of the manuscript. We are also indebted to Lisa Cohn for her scientific editorial review.

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Presented at the American Lung Association/American Thoracic Society International Conference, Anaheim, Calif, May 12–15, 1991.

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