Using nasal intermittent positive pressure ventilation on a general respiratory ward.
OBJECTIVE
To assess the use of nasal intermittent positive pressure ventilation (NIPPV) in treating acute-on-chronic respiratory failure in a general medical ward.


METHODS
Retrospective analysis of clinical outcome.


METHODS
A general medical ward of a tertiary respiratory medicine referral centre.


METHODS
Altogether 75 patients admitted with acute exacerbations of chronic respiratory failure and treated NIPPV.


METHODS
Blood gas tensions determined at admission to hospital and during NIPPV, tolerance of NIPPV and mortality.


RESULTS
During treatment with NIPPV, the mean (SD) PaO2 increased rapidly by 2.31 (3.58) kPa (p < 0.0001), while the mean PaCO2 fell by 1.07 (1.74) kPa (p < 0.0001) and the mean pH increased by 0.03 (0.07) (p = 0.001). Altogether 57 (76%) of patients tolerated NIPPV, and (9.3%) died in hospital. Improvement in PaO2 was more noticeable in patients with chronic obstructive pulmonary disease (+3.13 (3.49) kPa, p < 0.0001) than in those with restrictive chest wall disease (+1.20 (3.07) kPa, p = 0.25) or obstructive sleep apnoea (+0.18 (3.64), p = 0.88). The reduction in PaCO2 was similar in all three groups.


CONCLUSIONS
In routine treatment of unselected patients with acute-on-chronic respiratory failure who are being cared for on a general ward, NIPPV rapidly improves hypoxaemia and hypercapnia, is well tolerated and is associated with low mortality.
Department of Respiratory Medicine, London Chest Hospital.
J S
JS
Brown
D J
DJ
Meecham Jones
C
C
Mikelsons
E A
EA
Paul
J A
JA
Wedzicha
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D003627:Data Interpretation, Statistical; D005069:Evaluation Studies as Topic; D005260:Female; D006757:Hospital Units; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods; D008173:Lung Diseases, Obstructive / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012131:Respiratory Insufficiency / Q000097:blood / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000628:therapy; D016896:Treatment Outcome
D002245:Carbon Dioxide; D010100:Oxygen