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Open Access

Pressure support ventilation versus bilevel positive airway pressure for acute exacerbation of chronic obstructive pulmonary disease: a randomized trial

  • MA Scarpinella-Bueno1,
  • M RodriguesJr1,
  • C Hoelz1,
  • VM Amado1,
  • CSV Barbas1 and
  • E Knobel1
Critical Care20015(Suppl 3):P44

https://doi.org/10.1186/cc1377

Published: 26 June 2001

Keywords

Chronic Obstructive Pulmonary DiseaseRespiratory RateRespiratory FailureChronic Obstructive Pulmonary Disease PatientAcute Exacerbation

Objectives

Noninvasive positive pressure ventilation (NPPV) is widely used in an attempt to reduce the need for endotracheal intubation and mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). However, few controlled studies have compared pressure support ventilation by face mask (PSV) to bilevel positive airway pressure (BiPAP™) in patients with acute exacerbation of COPD. This study aims to compare these two modes of NPPV in acute hypercapnic respiratory failure in order to reduce respiratory rate (RR) and PaCO2 in an equivalent degree.

Method

Eleven consecutive adult patients admitted to the Critical Care Unit of Hospital Albert Einstein, São Paulo, Brazil, in acute respiratory failure due to exacerbation of COPD were randomized to receive PSV (n = 5) versus BiPAP™ (n = 6). Inclusion criteria were a high probability of acute exacerbation of COPD, RR above 24 breaths per minute, a PaCO2 above 45 mmHg, and arterial pH below 7.35 but above 7.10. Pressure support was used initially at 15-20 cmH2O (×=15.2 cmH2O) delivered through a facemask with a microprocessed ventilator. The patients allocated to BiPAP™ group received initially inspiratory pressure through a facemask at 20-25 cmH2O (×=21.3 cmH2O). The device was adjusted in the S/T mode.Positive end-expiratory pressure was 5 cmH2O. Oxygen was administered to provide an arterial oxygen saturation above 90%. The RR, arterial blood gases, arterial pressure, and heart rate were measured on admission, after 2 h, 6 h during NPPV, and 1 h after the patient was weaned.

Results

See Table.

Table

 

Mean

 

Mean

BiPAP

   

   RR_0h

30.6

PaCO2_0

77.6

   RR_2h

21.0*

PaCO2_2

66.9

   RR_6h

17.6*

PaCO2_6

67.0

   RR_7h

18.0*

PaCO2_7

63.9

PSV

   

   RR_0h

28.4

PaCO2_0

79.1

   RR_2h

24.0*

PaCO2_2

69.5

   RR_6h

19.4*

PaCO2_6

65.2

   RR_7h

18.4*

PaCO2_7

61.8

*P = 0.0001.

Discussion

NPPV is a commonly used therapy for the treatment of acute hypercapnic respiratory failure due to COPD exacerbation. The results reported here confirm the effectiveness of NPPV in improving COPD patients in acute respiratory failure. This is demonstrated by the significant fall in RR, the increase in oxygenation (not shown), and the fall in PaCO2 despite neither PSV or BiPAP™ reduced PaCO2 significantly. Comparing PSV and BiPAP™ both are effective.

Authors’ Affiliations

(1)
Albert Einstein Hospital, Critical Care Unit, São Paulo, Brazil

Copyright

© The Author(s) 2010

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