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Functional respiratory effects of noninvasive ventilation in acute hypercapnic patients with chronic obstructive pulmonary disease

Introduction

Noninvasive ventilation (NIV) is useful for improving oxygenation, decreasing hypercapnia, and avoiding invasive S4 mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD) exacerbations and acute respiratory failure [1, 2]. During the hospitalization, the treatment intensity is quite variable on the basis of the patient's clinical condition. Often, after the acute phase, patients need only periods of NIV followed by oxygenotherapy. NIV reduces the work of breathing and probably improves the respiratory muscular strength even when the ventilation is ended [3]. The aim of this study is to evaluate this effect in COPD submitted to NIV.

Methods

We studied 10 patients (seven male; three female; age 74.2 ± 5.3 years) admitted to our hospital with a COPD exacerbation and acute respiratory failure. After a period of clinical stabilization, patients underwent spirometry and arterial blood gas as basal examinations. For each patient, NIV was applied for 2 hours and than spirometry and arterial blood gas were repeated. Results are presented as mean ± SD. Data were evaluated by paired t test and a value of P < 0.05 was taken as statistically significant.

Results

At the end of NIV, the forced ventilatory capacity (FVC) and the forced expiratory volume at the first second (FEV1)/FVC ratio were significantly increased compared with the basal value: FVC 47.9 ± 11.0% basal, 55.3 ± 15.6% after NIV, P = 0.02; FEV1/FVC 68.5 ± 17.1 basal, 59.3 ± 15.2 after NIV, P = 0.007. Compared with the basal value, arterial carbon dioxide pCO2 was significantly decreased: 68.0 ± 2.5 mmHg (basal), 55.3 ± 4.5 mmHg (after NIV), P < 0.02; and arterial oxygen was increased: 50.0 ± 14.2 mmHg (basal), 56.3 ± 15.3 mmHg (after NIV).

Conclusion

The results of this study demonstrate that, in COPD exacerbation, NIV determines a decrease of the pulmonary hyperinflaction. This effect could improve the clinical status and the work of breathing.

References

  1. 1.

    West JB: COPD. In Pulmonary Physiology and Pathophysiology. Baltimore, MD: Lippincott Williams & Wilkins; 2001:33-53.

  2. 2.

    Brochard L: Mechanical ventilation: invasive versus non invasive. Eur Respir J 2003,22(Suppl 47):31s-37s. 10.1183/09031936.03.00050403

  3. 3.

    Lightowler JV, et al.: Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbation of COPD disease: Cochrane systematic review and meta-analysis. BMJ 2003, 326: 185-187. 10.1136/bmj.326.7382.185

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Keywords

  • Chronic Obstructive Pulmonary Disease
  • Mechanical Ventilation
  • Respiratory Failure
  • Arterial Oxygen
  • Acute Respiratory Failure