Nasal ventilation in COPD exacerbations: early and late results of a prospective, controlled study

Noninvasive positive pressure mechanical ventilation (NIPPV) in exacerbated chronic obstructive pulmonary disease (COPD) has been investigated early and after 1 yr of follow-up. To this end, 30 patients were enrolled in a prospective, controlled trial: 15 had early administration of NIPPV (Group A), 15 had medical therapy only (Group B); assignment was made on the basis of equipment availability only. In-hospital mortality, need for endotracheal intubation and mean length of hospitalization were lower in Group A, though the difference was not statistically significant. Arterial oxygen tension in arterial blood (Pa,O2), carbon dioxide tension in arterial blood (Pa,CO2) and HCO3- improved significantly in both groups from admission to discharge: 45.8+/-8.6 versus 64.9+/-10.0; 59.4+/-11.8 versus 48.6+/-7.3; 34.3+/-4.3 versus 30.1+/-3.4 in group A; 49.2+/-11.4 versus 60.9+/-8.2; 52.6+/-15.9 versus 44.4+/-8.7; 31.7+/-5.9 versus 28.0+/-3.6 in group B, respectively, p<0.05 for all comparisons; pH, percentage forced expiratory volume in one second (FEV1) and tidal volume (VT) improved significantly in patients of group A only: 7.36+/-0.04 versus 7.41+/-0.02; 39.8+/-13.6 versus 49.4+/-11.7; 0.71+/-0.3 versus 0.84+/-0.4, respectively, p<0.05. During follow-up, 3, 6, and 12 months survival rates were significantly higher in Group A than in Group B (p<0.02). Hospital new admissions over 1 yr were more frequent in Group B (n=6, incidence rate: 0.216%) than in Group A (n=4, incidence rate: 0.084%). Therefore, noninvasive positive pressure mechanical ventilation may be added to "conventional" medical therapy in exacerbated chronic obstructive pulmonary disease.

This article has been cited by other articles:

				M. W. Elliott Noninvasive ventilation in acute exacerbations of COPD Eur. Respir. Rev., September 1, 2005; 14(94): 39 - 42. [Abstract] [Full Text] [PDF]

				M. W. Elliott Non-invasive ventilation for acute respiratory disease Br. Med. Bull., March 31, 2005; 72(1): 83 - 97. [Abstract] [Full Text] [PDF]

				C M Chu, V L Chan, A W N Lin, I W Y Wong, W S Leung, and C K W Lai Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure Thorax, December 1, 2004; 59(12): 1020 - 1025. [Abstract] [Full Text] [PDF]

				P. Paggiaro Does Early Treatment of Exacerbation Improve Outcome in Chronic Obstructive Pulmonary Disease? Am. J. Respir. Crit. Care Med., June 15, 2004; 169(12): 1267 - 1268. [Full Text] [PDF]

				L. Brochard Mechanical ventilation: invasive versus noninvasive Eur. Respir. J., November 16, 2003; 22(47_suppl): 31s - 37s. [Abstract] [Full Text] [PDF]

				S. P. Keenan, T. Sinuff, D. J. Cook, and N. S. Hill Which Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Benefit from Noninvasive Positive-Pressure Ventilation? A Systematic Review of the Literature Ann Intern Med, June 3, 2003; 138(11): 861 - 870. [Abstract] [Full Text] [PDF]

				P K Plant and M W Elliott Chronic obstructive pulmonary disease * 9: Management of ventilatory failure in COPD Thorax, June 1, 2003; 58(6): 537 - 542. [Abstract] [Full Text] [PDF]

				M.W. Elliott, M. Confalonieri, and S. Nava Where to perform noninvasive ventilation? Eur. Respir. J., June 1, 2002; 19(6): 1159 - 1166. [Abstract] [Full Text] [PDF]

				L. Brochard, J. Mancebo, and M.W. Elliott Noninvasive ventilation for acute respiratory failure Eur. Respir. J., April 1, 2002; 19(4): 712 - 721. [Abstract] [Full Text] [PDF]

				P K Plant, J L Owen, and M W Elliott Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome Thorax, September 1, 2001; 56(9): 708 - 712. [Abstract] [Full Text] [PDF]

				L. BROCHARD Non-invasive ventilation for acute exacerbations of COPD: a new standard of care Thorax, October 1, 2000; 55(10): 817 - 818. [Full Text]