Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND In patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation may be used in an attempt to avoid endotracheal intubation and complications associated with mechanical ventilation. METHODS We conducted a prospective, randomized study comparing noninvasive pressure-support ventilation delivered through a face mask with standard treatment in patients admitted to five intensive care units over a 15-month period. RESULTS A total of 85 patients were recruited from a larger group of 275 patients with chronic obstructive pulmonary disease admitted to the intensive care units in the same period. A total of 42 were randomly assigned to standard therapy and 43 to noninvasive ventilation. The two groups had similar clinical characteristics on admission to the hospital. The use of noninvasive ventilation significantly reduced the need for endotracheal intubation (which was dictated by objective criteria): 11 of 43 patients (26 percent) in the noninvasive-ventilation group were intubated, as compared with 31 of 42 (74 percent) in the standard-treatment group (P < 0.001). In addition, the frequency of complications was significantly lower in the noninvasive-ventilation group (16 percent vs. 48 percent, P = 0.001), and the mean (+/- SD) hospital stay was significantly shorter for patients receiving noninvasive ventilation (23 +/- 17 days vs. 35 +/- 33 days, P = 0.005). The in-hospital mortality rate was also significantly reduced with noninvasive ventilation (4 of 43 patients, or 9 percent, in the noninvasive-ventilation group died in the hospital, as compared with 12 of 42, or 29 percent, in the standard-treatment group; P = 0.02). CONCLUSIONS In selected patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation, the length of the hospital stay, and the in-hospital mortality rate.

[1]  Lindell K. Weaver,et al.  Principles and Practice of Mechanical Ventilation , 1994 .

[2]  L. Brochard,et al.  Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. , 1994, American journal of respiratory and critical care medicine.

[3]  J. Wedzicha,et al.  Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease , 1993, The Lancet.

[4]  N. Hill Noninvasive Ventilation: Does it Work, for Whom, and How? , 1993 .

[5]  P. Montravers,et al.  Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. , 1993, The American journal of medicine.

[6]  M. Wysocki,et al.  Noninvasive pressure support ventilation in patients with acute respiratory failure. , 1993, Chest.

[7]  F. Portier,et al.  Nasal mask ventilation in acute respiratory failure. Experience in elderly patients. , 1992, Chest.

[8]  S. Scalvini,et al.  Acute exacerbations in severe COLD patients. Treatment using positive pressure ventilation by nasal mask. , 1992, Chest.

[9]  A D Bersten,et al.  Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. , 1991, The New England journal of medicine.

[10]  J. Chevrolet,et al.  Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses. , 1991, Chest.

[11]  R. Wunderink,et al.  Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. , 1991, Chest.

[12]  W. Chang,et al.  Acute Respiratory Failure during Splanchnic Nerve Block in COPD Patient , 1991 .

[13]  L. Brochard,et al.  Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. , 1990, The New England journal of medicine.

[14]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[15]  M. Elliott,et al.  Non-invasive mechanical ventilation for acute respiratory failure. , 1990, BMJ.

[16]  W. Sanborn Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. , 1989, The American review of respiratory disease.

[17]  A. Harf,et al.  Effect of air entrainment on airway pressure during endotracheal gas injection. , 1989, Journal of applied physiology.

[18]  G. Meduri,et al.  Noninvasive face mask ventilation in patients with acute respiratory failure. , 1989, Chest.

[19]  W. Gibbons,et al.  Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. , 1989, Chest.

[20]  T. Similowski,et al.  Acute respiratory failure of chronic obstructive pulmonary disease. , 1988, The American review of respiratory disease.

[21]  J. Chevrolet,et al.  Failure to predict six-month survival of patients with COPD requiring mechanical ventilation by analysis of simple indices. A prospective study. , 1987, Chest.

[22]  F Lemaire,et al.  Improved efficacy of spontaneous breathing with inspiratory pressure support. , 1987, The American review of respiratory disease.

[23]  J. L. Gall,et al.  A simplified acute physiology score for ICU patients , 1984, Critical care medicine.

[24]  S K Pingleton,et al.  Complications of acute respiratory failure. , 1988, The Medical clinics of North America.

[25]  J. Stauffer,et al.  Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. , 1981, The American journal of medicine.

[26]  D. Flenley,et al.  RESPIRATORY FAILURE REVISITED: ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS BETWEEN 1961-68 AND 1970-76 , 1980, The Lancet.

[27]  K. Kilburn,et al.  Survival after Acute Respiratory Failure: 145 Patients Observed 5 to 8½ Years , 1974 .

[28]  K. Kilburn,et al.  Survival after acute respiratory failure. 145 patients observed 5 to 8 and one-half years. , 1974, Annals of internal medicine.

[29]  R. George,et al.  Acute respiratory failure in chronic obstructive pulmonary disease. Immediate and long-term prognosis. , 1973, Archives of internal medicine.