title: Sequential use of noninvasive pressure support ventilation for acute exacerbations of COPD.
abstract: OBJECTIVE
  To compare the efficacy of noninvasive pressure support ventilation (NIPSV) in acute decompensation in chronic obstructive pulmonary disease (COPD) by means of a bi-level positive airway pressure support system (BiPAP) in a sequential mode with medical therapy alone; to assess the short-term physiologic effects of the device on gas exchange; and to compare patients successfully ventilated with NIPSV with those in whom NIPSV failed.
  
  
  METHODS
  A prospective case series with historically matched control study.
  
  
  METHODS
  A general intensive care unit (ICU) of a university hospital.
  
  
  METHODS
  We evaluated the efficacy of administration of NIPSV in 42 COPD patients and compared this with standard treatment in 42 matched historical control COPD patients.
  
  
  METHODS
  NIPSV was performed in a sequential mode, i.e., BiPAP in the spontaneous mode was used for at least 30 min every 3 h. Between periods of ventilation, patients could be systematically returned to BiPAP when the arterial oxygen saturation was < 0.85 or when the respiratory rate was > 30 breaths/min.
  
  
  RESULTS
  Success rate, mortality, duration of ventilatory assistance, and length of ICU stay were recorded. Eleven of the 42 patients (26%) in the NIPSV group needed tracheal intubation compared with 30 of the 42 control patients (71%). The 31 patients in whom NIPSV was successful were ventilated for a mean of 6 +/- 3 days. In-hospital mortality was not significantly different in the treated versus the control group, but the duration of ventilatory assistance (7 +/- 4 days vs 15 +/- 10 days, p < 0.01) and the length of ICU stay (9 +/- 4 days vs 21 +/- 12, p < 0.01) were both shortened by NIPSV. BiPAP was effective in correcting gas exchange abnormalities. The pH values, measured after 45 min of BiPAP with optimal settings, in the success (7.38 +/- 0.04) and failure (7.28 +/- 0.04) patients were significantly different (p < 0.05).
  
  
  CONCLUSIONS
  NIPSV, performed with a sequential mode, may be used in the management of patients with acute exacerbations of COPD.
authors.affiliation: Service de Réanimation Médicale B, Hôpital Pellegrin, Bordeaux, France.
authors.forename: G
authors.initials: G
authors.lastname: Hilbert
authors.forename: D
authors.initials: D
authors.lastname: Gruson
authors.forename: G
authors.initials: G
authors.lastname: Gbikpi-Benissan
authors.forename: J P
authors.initials: JP
authors.lastname: Cardinaud
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000401:mortality / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012123:Pulmonary Ventilation