Elsevier

Respiratory Medicine

Volume 99, Issue 8, August 2005, Pages 976-984
Respiratory Medicine

Long-term reduction of hyperinflation in stable COPD by non-invasive nocturnal home ventilation

https://doi.org/10.1016/j.rmed.2005.02.007Get rights and content
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Summary

Objective

The role of non-invasive positive pressure ventilation (NPPV) in stable COPD with chronic ventilatory failure remains controversial. The impact of long-term home nocturnal NPPV treatment on deflation has not yet been evaluated in detail.

Methods

Retrospective explorative study of 46 patients with stable COPD undergoing NPPV treatment. Effects of NPPV on bodyplethysmographic parameters, blood gas tensions and inspiratory muscle function after 6.2 (±1.7) and 12.7 (±2.1) months of treatment. Further, evaluation of 1-year survival, compliance and ventilation parameters.

Results

One-year survival was 89.1%. The effectiveness of ventilation was proven by a significant reduction in nocturnal and daytime PaCO2. We observed a decrease in the ratio of residual volume (RV) to total lung capacity (TLC) on the average of 5.2±9.8% (or 15.2±29.7% pred.; P<0.01) at six and 3.9±9.0% (or 12.9±18.6% pred.; P<0.001) at 12 months. As a consequence, we found significant improvements in inspiratory capacity (IC), vital capacity (VC) and forced expiratory volume in one second (FEV1). For patients with the most severe hyperinflation (RV/TLC>75%), we found a significant positive correlation between inspiratory positive airway pressure (IPAP) and reductions in PaCO2 (r=0.56; P<0.05) and RV/TLC (r=0.50; P<0.05).

Conclusions

In severe hypercapnic stable COPD long-term nocturnal NPPV can reduce hyperinflation with sustained improved daytime blood gas parameters.

Keywords

COPD
Non-invasive positive pressure ventilation
Chronic respiratory failure
Hyperinflation

Abbreviations

BE
base excess
BMI
body-ass index
CPAP
continuous positive airway pressure
COPD
chronic obstructive pulmonary disease
CRP
C-reactive protein
EPAP
expiratory positive airway pressure
EELV
end-expiratory lung volume
FEV1
forced expiratory volume in one second
Hb
haemoglobin
HRQL
health-related quality of life
IC
inspiratory capacity
IPAP
inspiratory positive airway pressure
LTOT
long-term oxygen therapy
NPPV
non-invasive positive pressure ventilation
P0.1
mouth occlusion pressure at 100 ms
PaCO2
arterial carbon dioxide tension
PaO2
arterial oxygen tension
PEEPi
intrinsic positive end-expiratory pressure
PImax
maximal inspiratory pressure
RV/TLC
ratio residual volume/total lung capacity
SaO2
arterial oxygen saturation
SRtot
total specific resistance
TLC
total lung capacity
VC
vital capacity

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