Chest
Preliminary ReportContinuous Positive Airway Pressure in COPD Patients in Acute Hypercapnic Respiratory Failure
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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2003, Medical Journal Armed Forces IndiaCitation Excerpt :Noninvasive ventilatory support could be either continuous positive airway pressure (CPAP) or combination of continuous positive airway pressure and pressure support ventilation (PSV). The application of continuous positive airway pressure at levels that approach 80% to 90% of the measured intrinsic positive and expiratory pressure (PEEP) values may reduce the work of breathing without causing further hyperinflation [4]. The addition of pressure support may further assist ventilation by increasing tidal volume, decreasing respiratory frequency, and further reducing the inspiratory work of breathing performed by the respiratory muscles [5].
Presented at the American Lung Association/American Thoracic Society International Conference, Anaheim, Calif, May 12–15, 1991.