NASAL INTERMITTENT POSITIVE PRESSURE VENTILATION IN ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - A PRELIMINARY-STUDY

Ten patients (two male) suffering from acute exacerbations of long-standing chronic obstructive pulmonary disease and admitted in hypoxic, hypercapnic respiratory failure were treated with Nasal Intermittent Positive Pressure Ventilation (NIPPV) plus supplemental oxygen, on a general medical ward. The median (range) pH on admission was 7·30 (7·20-7·35), the median age was 67 years (47-77) with an FEV1 (percent of predicted) of 30 (17-39). On admission the median arterial oxygen tension (PaO2) was 4·71 kPa (3·45-6·26) on air, and the carbon dioxide tension (PaCO2) was 7·68 kPa (6·85-9·83). With controlled oxygen therapy there was no significant improvement in PaO2, but the median PaCO2 increased significantly to 9·75 kPa (7·04-11·70) (P < 0·05). By using NIPPV with supplemental oxygen it was possible to significantly improve the median PaO2 to 11·25 kPa (6·70-26·90) (P < 0·01) without worsening PaCO2 levels (8·96 kPa; 6·85-13·10). NIPPV was applied by a senior, respiratory physiotherapist and used intermittently depending on patient tolerance and clinical response. The median total time on NIPPV was 27 h, delivered over 1-5 days. One patient found the mask difficult to tolerate beyond a short period of time. NIPPV was well accepted on a general ward by nursing staff. Three patients later died with progressive hypercapnia, despite an initial response; with one of these patients also receiving intubation and mechanical ventilation. A further patient also received intubation and mechanical ventilation and was eventually discharged. NIPPV plus supplemental oxygen offers a method to correct hypoxaemia on a general medical ward without worsening hypercapnia for acute on chronic, hypoxic, hypercapnic respiratory failure, and warrants further investigation. © 1993.