REVERSAL OF ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE LUNG-DISEASE BY INSPIRATORY ASSISTANCE WITH A FACE MASK

Background. Patients with acute exacerbations of chronic obstructive pulmonary disease may require endotracheal intubation with mechanical ventilation. We designed, and here report on the efficacy of, a noninvasive ventilatory-assistance apparatus to provide inspiratory-pressure support by means of a face mask. Methods. We assessed the short-term (45-minute) physiologic effects of the apparatus in 11 patients with acute exacerbations of chronic obstructive pulmonary disease and evaluated its therapeutic efficacy in 13 such patients (including 3 of the 11 in the physiologic study) who were treated for several days and compared with 13 matched historical-control patients. Results. In the physiologic study, after 45 minutes of inspiratory positive airway pressure by face mask, the mean (±SD) arterial pH rose from 7.31±0.08 to 7.38±0.07 (P<0.01), the partial pressure of carbon dioxide fell from 68±17 mm Hg to 55±15 mm Hg (P<0.01), and the partial pressure of oxygen rose from 52±12 mm Hg to 69±16 mm Hg (P<0.05). These changes were accompanied by marked reductions in respiratory rate (from 31±7 to 21±9 breaths per minute, P<0.01). Only 1 of the 13 patients treated with inspiratory positive airway pressure needed tracheal intubation and mechanical ventilation, as compared with 11 of the 13 historical controls (P<0.001). Two patients in each group died. As compared with the controls, the treated patients had a more transient need for ventilatory assistance (3±1 vs. 12±11 days, P<0.01) and a shorter stay in the intensive care unit (7±3 vs. 19±13 days, P<0.01). Conclusions. Inspiratory positive airway pressure delivered by a face mask can obviate the need for conventional mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease. (N Engl J Med 1990; 323:1523–30.). © 1990, Massachusetts Medical Society. All rights reserved.