Effectiveness of non-invasive positive pressure ventilation differs between decompensated chronic restrictive and obstructive pulmonary disease patients.
OBJECTIVE
To compare the efficiency of non-invasive positive pressure ventilation (NPPV) in decompensated patients with either chronic obstructive pulmonary disease (COPD) or chronic restrictive pulmonary disease.


METHODS
Retrospective study.


METHODS
A 17-bed intensive care unit in a university teaching hospital.


METHODS
Sixty-four patients with COPD (age: 70+/-13 years, sex ratio: 37 male to 27 female patients, forced expiratory volume in 1 s: 31+/-13% predicted) and 20 patients with chronic restrictive pulmonary disease (age: 75+/-9 years, sex ratio: 9 male to 11 female patients, total lung capacity: 57+/-17% predicted) consecutively treated with NPPV (facial mask, pressure support ventilation (PSV) +/- PEEP) for acute respiratory failure.


RESULTS
There were no statistically significant differences between COPD and patients with chronic restrictive pulmonary disease in terms of cause of exacerbation, use of oxygen therapy or NPPV at home, severity of acute respiratory failure (ARF), mean delay from intensive care admission to initiation of NPPV and total duration of NPPV. Patients with chronic restrictive pulmonary disease had a lower success rate on NPPV (without need of tracheal intubation) than COPD (35% vs 67%, p=0.01). Causes of NPPV failure were not different between COPD and patients with restrictive disease. After 12 h of NPPV, restrictive patients who succeeded with NPPV had similar respiratory rate, minute ventilation and arterial blood gas to COPD patients. At the 3rd and 12th h of NPPV, improvements in pH and PaCO(2) were predictive of NPPV success in COPD, but not in restrictive patients.


CONCLUSIONS
The results of this retrospective study suggest that the effectiveness of NPPV for acute decompensation is less in patients with chronic restrictive pulmonary disease as compared to COPD.
Robino
Christophe
C
Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
Faisy
Christophe
C
Diehl
Jean-Luc
JL
Rezgui
Nacer
N
Labrousse
Jacques
J
Guerot
Emmanuel
E
D000368:Aged; D001784:Blood Gas Analysis; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D008297:Male; D011175:Positive-Pressure Respiration; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome