title: Comparison of the acute effects on gas exchange of nasal ventilation and doxapram in exacerbations of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Nasal intermittent positive pressure ventilation (NIPPV) is useful in exacerbations of chronic obstructive pulmonary disease (COPD) complicated by ventilatory failure. The effects of NIPPV were compared with those of the respiratory stimulant doxapram on gas exchange in patients with COPD and acute ventilatory failure.
  
  
  METHODS
  Patients admitted with acute exacerbations of COPD and type 2 respiratory failure (Pao2 < 8 kPa and PaCO2 > 6.7 kPa) who did not improve with conventional treatment were randomised to receive either NIPPV or intravenous doxapram. Blood gas tensions were monitored for four hours.
  
  
  RESULTS
  In nine patients who received NIPPV the arterial PaO2 improved from a mean (SE) of 5.9 (0.4) kPa to a maximum of 8.1 (0.6) kPa which was maintained at four hours. Eight patients who received doxapram had a similar baseline Pao2 of 5.6 (0.4) kPa which rose to a maximum of 7.3 (0.5) kPa but this was not maintained at four hours. The improvement in Pao2 in patients on NIPPV was accompanied by a fall in Paco2 but, in contrast, in those who received doxapram there was no improvement in Paco2.
  
  
  CONCLUSIONS
  NIPPV may be more effective than doxapram in the management of acute ventilatory failure complicating COPD.
authors.affiliation: Department of Respiratory Medicine, Western Infirmary and Gartnavel General Hospital, Glasgow, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Angus
authors.forename: A A
authors.initials: AA
authors.lastname: Ahmed
authors.forename: L J
authors.initials: LJ
authors.lastname: Fenwick
authors.forename: A J
authors.initials: AJ
authors.lastname: Peacock
mesh_terms: D004315:Doxapram / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D012131:Respiratory Insufficiency / Q000209:etiology; D019141:Respiratory System Agents / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D019141:Respiratory System Agents; D004315:Doxapram; D010100:Oxygen