Chest
Volume 105, Issue 1, January 1994, Pages 100-105
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Clinical Investigations: COPD
Nasal Intermittent Positive Pressure Ventilation: Long-term Follow-up in Patients With Severe Chronic Respiratory Insufficiency

https://doi.org/10.1378/chest.105.1.100Get rights and content

Prior studies have shown that nasal intermittent positive pressure ventilation (NIPPV) can improve arterial blood gas values, prevent symptoms resulting from alveolar hypoventilation, and decrease hospitalization in patients with chronic respiratory failure. Most studies have involved small samples of patients followed up for a limited time. This study reviews our experience during 5 years use of NIPPV in 276 patients with kyphoscoliosis, posttuberculosis sequelae, Duchenne-type muscular dystrophy, COPD, and bronchiectasis followed up for ≥3 years while receiving NIPPV. Outcomes were compared for patients who survived short term, eg, died or converted to management with a tracheostomy and intermittent positive ventilation (TIPPV) during year 1 or year 2 on a regimen of NIPPV and long term, eg, survived more ≥2 years on a regimen of NIPPV. Ihe most favorable outcome was achieved by patients with kyphoscoliosis and posttubenculous sequelae with improvement in PaO2 and PaCO2 (p<0.0001) and a reduction in days of hospitalization for respiratory illness (p<0.0001) for ≥2 years while receiving NIPPV. Patients with Duchenne-type muscular dystrophy also had fewer hospital days during NIPPV (p<0.003) but only 9 of 16 patients (56 percent) continued using NIPPV for the duration of followup. Benefit was also more short term for patients with COPD and bronchiectasis. NIPPV can sustain improvement in gas exchange, while reducing hospitalization for substantial periods of time. NIPPV can be an attractive and effective alternative to other methods of assisted ventilation such as TIPPV.

Section snippets

Methods

Subjects were 276 patients diagnosed as having idiopathic kyphoscoliosis, posttuberculosis sequelae, Duchenne-type muscular dystrophy, COPD, and bronchiectasis. All were treated with NIPPV between 1985 and 1990 by four French teams in an integrated system consisting of hospital units and home care associations. Data were obtained by the teams and compiled by one of the researchers (P.L.). The sample included all patients treated with NIPPV during this time, with the exception of 94 patients.

Results

Table 1 presents a profile of the 276 patients. Pulmonary function tests reflected severe restrictive or obstructive disease. Mean ABG values indicated severe hypoxemia and hypercarbia for all groups, with the exception of those diagnosed as having Duchenne-type muscular dystrophy. A substantial number of patients with COPD (88 percent), bronchiectasis (84 percent), kyphoscoliosis (54 percent), and posttuberculosis sequelae (64 percent) were receiving long-term oxygen therapy.

Discussion

Since its introduction in 1984, NIPPV has become an established method of treatment for patients with restrictive chest wall disorders and neuromuscular diseases. In addition, NIPPV may have the potential to benefit other patients, such as those with COPD or bronchiectasis. Few studies have evaluated this possibility in patients in COPD and no studies were identified that evaluated effects of NIPPV in patients with bronchiectasis. Therefore, we initiated this study.

Our results demonstrate that

ACKNOWLEDGEMENTS

The authors wish to acknowledge the assistance of the home care nurses, respiratory therapists, and technicians who assisted with patient care and data collection during this study and thank Leslie A. Hoffman, R.N., Ph.D., for invaluable aid in writing of this manuscript.

References (26)

  • BranthwaiteM.A.

    Non-invasive and domiciliary ventilation; positive pressure techniques

    Thorax

    (1991)
  • ConwayJ. et al.

    The successful reversal of hypoxia using nasal intermittent positive pressure ventilation plus added oxygen in respiratory failure due to acute exacerbations of chronic airways disease [abstract]

    Am Rev Respir Dis

    (1991)
  • GoutorbeF. et al.

    Acute failure of chronic respiratory insufficiency treated by nasal mechanical ventilation [abstract]

    Am Rev Respir Dis

    (1990)
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