Noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease in patients with and without home noninvasive ventilation

Abstract

Objective: The frequency of home ventilation has increased greatly. The objective of the study was, first, to compare the outcome of episodes of acute exacerbation of chronic obstructive pulmonary disease treated with mask intermittent positive-pressure ventilation (MIPPV) in patients with home MIPPV and in patients without home ventilatory support and, second, for each category of patients, to compare patients successfully ventilated with MIPPV with those who failed with MIPPV.

Design: Prospective, controlled, nonrandomized clinical study.

Setting: Medical intensive care unit of a university hospital.

Patients: In the groups with and without home MIPPV, respectively, 31 and 78 episodes of acute exacerbations of chronic obstructive pulmonary disease were studied.

Interventions: MIPPV was performed in a sequential mode and delivered through a full-face mask with a bilevel positive airway pressure system.

Measurements and main results: The clinical and functional characteristics of the two groups, at admission, were similar. In groups with and without home ventilation, respectively, success rates were 68% and 72% (p =.68), length of intensive care unit stay was 8 +/- 6 and 10 +/- 4 days (p =.02), and intensive care unit deaths were 13% and 8% (p =.30). In survivors and in groups with and without home ventilation, respectively, the total time of ventilatory assistance in intensive care unit was 5 +/- 4 and 8 +/- 4 days (p =.004), and the length of intensive care unit stay was 7 +/- 5 and 10 +/- 4 days (p =.003). A greater correction of pH, after 45 mins of MIPPV with optimal settings, was recorded in the success patients than in the failure patients, respectively; in the group with home MIPPV, the pH after 45 mins was 7.34 +/- 0.04 vs. 7.31 +/- 0.04 (p =.06), and in the group without home MIPPV, pH was 7.34 +/- 0.04 vs. 7.30 +/- 0.04 (p =.001).

Conclusion: MIPPV may also be favorable during episodes of acute exacerbations in patients with chronic obstructive pulmonary disease. Experience with MIPPV could benefit selected patients in the management of acute respiratory failure.