High-intensity non-invasive positive pressure ventilation for stable hypercapnic COPD

Wolfram Windisch, Moritz Haenel, Jan H Storre, Michael Dreher, Wolfram Windisch, Moritz Haenel, Jan H Storre, Michael Dreher

Abstract

Background: The objective of the present analysis is to describe the outcomes of high-intensity non-invasive positive pressure ventilation (NPPV) aimed at maximally decreasing PaCO(2) as an alternative to conventional NPPV with lower ventilator settings in stable hypercapnic COPD patients.

Methods: Physiological parameters, exacerbation rates and long-term survival were assessed in 73 COPD patients (mean FEV(1) 30+/-12 %predicted) who were established on high-intensity NPPV due to chronic hypercapnic respiratory failure between March 1997 and May 2006.

Results: Controlled NPPV with breathing frequencies of 21+/-3 breath/min and mean inspiratory/expiratory positive airway pressures of 28+/-5/5+/-1 cmH(2)O led to significant improvements in blood gases, lung function and hematocrit after two months. Only sixteen patients (22%) required hospitalisation due to exacerbation during the first year, with anaemia increasing the risk for exacerbation. Two- and five-year survival rates of all patients were 82% and 58%, respectively. The five year survival rate was 32% and 83% in patients with low (< or =39%) and high (> or =55%) hematocrit, respectively.

Conclusion: High-intensity NPPV improves blood gases, lung function and hematocrit, and is also associated with low exacerbation rates and a favourable long-term outcome. The current report strongly emphasises the need for randomised controlled trials evaluating the role of high-intensity NPPV in stable hypercapnic COPD patients.

Keywords: COPD; exacerbation; hematocrit; non-invasive ventilation; survival.

Conflict of interest statement

Competing interest: The study group received an open research grant from Breas Medical AB, Molnlycke, Sweden. The authors state that neither the study design, the results, the interpretation of the findings, nor any other subject discussed in the submitted manuscript was dependent on support.

References

    1. Kolodziej MA, Jensen L, Rowe B, Sin D. Systematic review of noninvasive positive pressure ventilation in severe stable COPD. Eur Respir J. 2007;30:293–306.
    1. Lloyd-Owen SJ, Donaldson GC, Ambrosino N et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J. 2005;25:1025–31.
    1. Casanova C, Celli BR, Tost L et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest. 2000;118:1582–90.
    1. Clini E, Sturani C, Rossi A et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J. 2002;20:529–38.
    1. Wijkstra PJ. Non-invasive positive pressure ventilation (NIPPV) in stable patients with chronic obstructive pulmonary disease (COPD) Respir Med. 2003;97:1086–93.
    1. Wijkstra PJ, Lacasse Y, Guyatt GH et al. A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD. Chest. 2003;124:337–43.
    1. Windisch W, Vogel M, Sorichter S et al. Normocapnia during nIPPV in chronic hypercapnic COPD reduces subsequent spontaneous PaCO2. Respir Med. 2002;96:572–9.
    1. Windisch W, Kostic S, Dreher M, Virchow JCJ, Sorichter S. Outcome of patients with stable COPD receiving controlled noninvasive positive pressure ventilation aimed at a maximal reduction of PaCO2. Chest. 2005;128:657–62.
    1. Windisch W, Dreher M, Storre JH, Sorichter S. Nocturnal non-invasive positive pressure ventilation: Physiological effects on spontaneous breathing. Respir Physiol Neurobiol. 2006;150:251–60.
    1. Dreher M, Storre JH, Windisch W. Noninvasive ventilation during walking in patients with severe COPD: a randomised cross-over trial. Eur Respir J. 2007;29:930–6.
    1. Sutherland ER, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2689–97.
    1. Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000;117:398S–401S.
    1. Casas A, Troosters T, Garcia-Aymerich J et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28:123–30.
    1. Simonds AK, Elliott MW. Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders. Thorax. 1995;50:604–9.
    1. Sivasothy P, Smith IE, Shneerson JM. Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease. Eur Respir J. 1998;11:34–40.
    1. Leger P, Bedicam JM, Cornette A et al. Nasal intermittent positive pressure ventilation. Long-term follow-up in patients with severe chronic respiratory insufficiency. Chest. 1994;105:100–5.
    1. Chambellan A, Chailleux E, Similowski T. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy. Chest. 2005;128:1201–8.
    1. Budweiser S, Jorres RA, Riedl T et al. Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation. Chest. 2007;131:1650–8.
    1. de Leeuw PW, Dees A. Fluid homeostasis in chronic obstructive lung disease. Eur Respir J Suppl. 2003;46:33s–40s.
    1. Windisch W. Impact of home mechanical ventilation on health-related quality of life. Eur Respir J. 2008 Nov;32(5):1328–36.
    1. Windisch W, Hennings E, Sorichter S, Hamm H, Criee CP. Peak or plateau maximal inspiratory mouth pressure: which is best? Eur Respir J. 2004;23:708–13.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi