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Clinical Investigations in Critical CareComparison of Noninvasive Positive Pressure Ventilation With Standard Medical Therapy in Hypercapnic Acute Respiratory Failure
Section snippets
Materials and Methods
Between March 1993 and August 1996, all patients with acute exacerbation of COPD evaluated in the emergency department were considered for the study. The ethics committee of Marmara University Medical Faculty approved the study. Informed consent was obtained from the patients or, if the patient was unable, informed consent was obtained from a first-degree relative.
Patients included into the study were known to have COPD diagnosed on the basis of previous pulmonary function testing (FEV1/FVC <
Results
Thirty patients were enrolled in the study. Fifteen patients were randomized to the ST group and 15 patients to the NPPV plus ST group. Pulmonary function data were available at study initiation in eight of the patients in the ST group and seven of those in the NPPV group. In, respectively, the ST and NPPV groups, pulmonary function data were as follows: FEV1 (1 ± 0.33 L [40% ± 14% of the predicted value], 1.03 ± 0.19 [38% ± 11%]); FVC (1.72 ± 0.82 L [56% ± 18% of predicted], and 2.12 ± 0.46 L
Discussion
With ST, approximately 25% of COPD patients in ARF require mechanical ventilation.18 The application of noninvasive mechanical ventilation for these patients is widely accepted. However, there are, to date and to our knowledge, only four published, prospective and randomized studies comparing noninvasive mechanical ventilation with ST in this situation.15, 16, 17,19 Survival, or avoidance of endotracheal intubation, was significantly better with noninvasive mechanical ventilation in all except
Acknowledgment
The authors thank our medical housestaff, medical ICU nurses for their support of the study, Nural Bekiroglu for statistical analysis, and Joseph Layon, MD, FCCP, for revision of the article.
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