Chest
Volume 108, Issue 6, December 1995, Pages 1572-1576
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Clinical Investigations: Ventilation
Noninvasive Nasal Mask Ventilation Beyond the ICU for an Exacerbation of Chronic Respiratory Insufficiency

https://doi.org/10.1378/chest.108.6.1572Get rights and content

Study objective

To assess the usefulness of noninvasive nasal mask ventilation (NMV) in the treatment of an exacerbation of chronic respiratory insufficiency in patients stable enough to be admitted to a non-ICU ward.

Design

A prospective study in which the beneficial effect of NMV was compared with conservative treatment.

Setting

A ward of respiratory medicine of a tertiaryreferral teaching hospital.

Patients

The study group included 15 patients with acute respiratory acidosis. These patients had pH less than 7.35 and PaO2 more than 60 mm Hg, respiratory rate of 30 breaths or less per minute, hemodynamic stability, and alertness and willingness of cooperation with the NMV treatment. The control group consisted of 16 patients who fulfilled the same arterial blood gas requirements, retrospectively selected from the discharge forms of the ward of respiratory medicine for the year 1993.

Interventions

Patients underwent NMV for two sessions per day (one in the morning and one in the afternoon), each session lasting 4 h. A volumetric respirator (Monnal D; Taema; Paris, France) was used in four patients with restrictive disease. A positive-pressure ventilator (DP90; Taema; Paris, France) was used in 11 patients with obstructive disease. Control patients received standard medical, oxygen, and chest physical therapy.

Results

As compared with pre-NMV values, mean pH was significantly higher at 4 h of NMV after the patient's ventilatory adaptation (t=8.814, p<0.001) and at the end of NMV (t=12.06, p<0.001). Ventilatory support also produced a significant improvement in hypercapnia (pre-NMV vs NMV after the patient's ventilatory adaptation, t=6.675, p<0.001; pre-NMV vs post-NMV, t=6.976, p<0.001). Posttreatment pH and PaCO2 values were significantly higher and lower, respectively, in NMV-treated patients than in controls. At the end of treatment, a significantly higher PaO2/FIo2 ratio was documented in the study group than in controls (post-NMV vs posttreatment, t=2.846, p<0.01). Conclusions: NMV associated with standard treatment may be more beneficial than conservative treatment alone for improving blood gas exchange in patients with chronic respiratory insufficiency admitted to the hospital (but not the ICU) for an episode of acute decompensation and respiratory acidosis.

Section snippets

MATERIALS AND Methods

The study protocol was approved by the ethical research committee of our hospital, and informed consent of participants was obtained.

Results

Seventeen consecutive qualified patients were entered into the study. Thirteen patients had COPD and 4 had kyphoscoliosis resulting in chronic restrictive respiratory disease. Of the 17 patients who met the entrance criteria, one patient with obstructive disease was not able to sustain NMV for longer than 20 min (IPAP at 7 cm H2O) due to an apparent and unexplained inability to keep his mouth closed. A further patient with COPD was not able to cope with the DP90 ventilator because tachypnea (33

Discussion

Our results demonstrate that NMV can achieve a significant improvement in gas exchange in patients with chronic respiratory insufficiency and acute respiratory acidosis hospitalized beyond the ICU. In the series reported by Leger and colleagues5 in which most subjects had restrictive chest wall disorders and neuromuscular diseases, nasal intermittent positive-pressure ventilation was provided by a volume-cycled ventilator. In the present study, volumetric respirators (Monnal D) were also used

Acknowledgment

We thank Marta Pulido, MD, for the English translation of the manuscript.

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