Daytime mechanical ventilation in chronic respiratory insufficiency

Chronic respiratory insufficiency (CRI) is associated with nocturnal hypoventilation. Treatment with noninvasive mechanical ventilation (NIMV) performed overnight relieves symptoms of hypoventilation and improves daytime blood gases in CRI. In order to test whether the efficacy of NIMV depends on it being applied during sleep, we conducted a prospective case-controlled study comparing daytime mechanical ventilation (dMV) in awake patients with nocturnal mechanical ventilation (nMV) given in equal quantities. We enrolled 34 clinically stable patients (age 56.1+/-12.1 yrs, 20 females, 14 males) with CRI due to restrictive lung and chest wall disorders and neuromuscular disease. Using a prospective case-control design, matched subjects were allocated alternately to dMV and nMV. After 1 month of NIMV there was considerable symptomatic improvement in both dMV and nMV patients. There were no significant differences between groups in the improvement in daytime arterial carbon dioxide tension (Pa,CO2) (dMV from 7.5+/-0.6 to 5.7+/-0.6 kPa; nMV from 7.2+/-0.5 to 5.8+/-0.5 kPa, p<0.0001) and during the unassisted spontaneous night-time ventilation in terms of transcutaneous Pa,CO2 (dMV from 8.4+/-1.2 to 6.6+/-0.7 kPa; nMV from 8.2+/-1.2 to 6.8+/-0.5 kPa, p<0.0001). We conclude that in many respects, when compared to nocturnal mechanical ventilation, daytime mechanical ventilation in awake patients is equally effective at reversing chronic respiratory insufficiency. Since long-term safety issues were not addressed in this study, we recommend that nocturnal mechanical ventilation should remain the modality of choice for noninvasive mechanical ventilation.

This article has been cited by other articles:

				M. Toussaint, M. Chatwin, and P. Soudon Review Article: Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience Chronic Respiratory Disease, August 1, 2007; 4(3): 167 - 177. [Abstract] [PDF]

				M. Toussaint, M. Steens, and P. Soudon Lung Function Accurately Predicts Hypercapnia in Patients With Duchenne Muscular Dystrophy Chest, February 1, 2007; 131(2): 368 - 375. [Abstract] [Full Text] [PDF]

				O. Diaz, P. Begin, M. Andresen, M. E. Prieto, C. Castillo, J. Jorquera, and C. Lisboa Physiological and clinical effects of diurnal noninvasive ventilation in hypercapnic COPD Eur. Respir. J., December 1, 2005; 26(6): 1016 - 1023. [Abstract] [Full Text] [PDF]

				M W Elliott Non-invasive ventilation in acute exacerbations of COPD: what happens after hospital discharge? Thorax, December 1, 2004; 59(12): 1006 - 1008. [Full Text] [PDF]

				A.K. Simonds Home ventilation Eur. Respir. J., November 16, 2003; 22(47_suppl): 38s - 46s. [Abstract] [Full Text] [PDF]

				O. Diaz, P. Begin, B. Torrealba, E. Jover, and C. Lisboa Effects of noninvasive ventilation on lung hyperinflation in stable hypercapnic COPD Eur. Respir. J., December 1, 2002; 20(6): 1490 - 1498. [Abstract] [Full Text] [PDF]

				R. Porta, L. Appendini, M. Vitacca, L. Bianchi, C. F. Donner, R. Poggi, and N. Ambrosino Mask Proportional Assist vs Pressure Support Ventilation in Patients in Clinically Stable Condition With Chronic Ventilatory Failure* Chest, August 1, 2002; 122(2): 479 - 488. [Abstract] [Full Text] [PDF]

				A. Cuvelier and J-F. Muir Noninvasive ventilation and obstructive lung diseases Eur. Respir. J., June 1, 2001; 17(6): 1271 - 1281. [Abstract] [Full Text] [PDF]

				S. MEHTA and N. S. HILL Noninvasive Ventilation Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 540 - 577. [Full Text]

				M. Vitacca, S. Nava, M. Confalonieri, L. Bianchi, R. Porta, E. Clini, and N. Ambrosino The Appropriate Setting of Noninvasive Pressure Support Ventilation in Stable COPD Patients Chest, November 1, 2000; 118(5): 1286 - 1293. [Abstract] [Full Text] [PDF]

				P M Turkington and M W Elliott Rationale for the use of non-invasive ventilation in chronic ventilatory failure Thorax, May 1, 2000; 55(5): 417 - 423. [Full Text]

				B. Schönhofer and D. Köhler Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in patients with chronic respiratory failure Thorax, April 1, 2000; 55(4): 308 - 313. [Abstract] [Full Text]