Chest
Clinical InvestigationsOutcome of Patients With Stable COPD Receiving Controlled Noninvasive Positive Pressure Ventilation Aimed at a Maximal Reduction of Paco2
Section snippets
Patients
All patients with COPD who were stable and hypercapnic, and who presented with typical symptoms of HRF such as fatigue, dyspnea, and morning headache despite supplemental oxygen and administration of bronchodilators were offered NPPV. There were no predefined criteria to decide which patients were not to receive NPPV. Patients who were established on NPPV between March 1997 and September 2003 were included in the analysis. All patients were treated on the general ward at the Department of
Results
Forty-eight patients were identified from the registry, in whom COPD was diagnosed as the leading cause of chronic HRF and who received NPPV for HMV (Fig 1). Fourteen patients did not qualify for further analysis: 5 patients were established on pressure-limited NPPV during unstable disease; 6 patients received volume-limited ventilation during unstable disease; data of 3 patients were not available: 1 patient moved to another area; 1 patient discontinued NPPV due to long-term normalization of
Discussion
In the present analysis, controlled NPPV using relatively high inspiratory pressures with a mean of 28 cm H2O has been shown to significantly improve lung function and blood gas levels during spontaneous breathing in patients with stable hypercapnic COPD. Thereby, FEV1increased by a mean of 0.14 L, Paco2could be decreased by a mean of nearly 7 mm Hg, and Pao2could be increased by nearly 6 mm Hg following 2 months of predominantly nocturnally applied NPPV. This is in contrast to a 8 of four RCTs
Conclusion
Controlled NPPV using a high mean inspiratory pressure of 28 cm H2O is well tolerated over a prolonged period by patients with stable HRF due to COPD after careful adaptation to NPPV in the hospital. This treatment can lead to a significant improvement in lung function and blood gas levels during spontaneous breathing. Further RCTs using NPPV with higher inspiratory pressures are needed to verify the benefits of NPPV on outcome in these patients.
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