Intrapulmonary percussive ventilation in acute exacerbations of COPD patients with mild respiratory acidosis: a randomized controlled trial [ISRCTN17802078].
BACKGROUND
We hypothesized that the use of intrapulmonary percussive ventilation (IPV), a technique designed to improve mucus clearance, could prove effective in avoiding further deterioration in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) with mild respiratory acidosis.


METHODS
The study was performed in a medical intensive care unit of a university hospital. Thirty-three patients with exacerbations of COPD with a respiratory frequency >or= 25/min, a PaCO2 > 45 Torr and 7.35 <or= pH <or= 7.38 were included in the study. Patients were randomly assigned to receive either standard treatment (control group) or standard treatment plus IPV (IPV group). The IPV group underwent two daily sessions of 30 minutes performed by a chest physiotherapist through a full face mask. The therapy was considered successful when both worsening of the exacerbation and a decrease in pH to under 7.35, which would have required non-invasive ventilation, were avoided.


RESULTS
Thirty minutes of IPV led to a significant decrease in respiratory rate, an increase in PaO2 and a decrease in PaCO2 (p < 0.05). Exacerbation worsened in 6 out of 17 patients in the control group versus 0 out of 16 in the IPV group (p < 0.05). The hospital stay was significantly shorter in the IPV group than in the control group (6.8 +/- 1.0 vs. 7.9 +/- 1.3 days, p < 0.05).


CONCLUSIONS
IPV is a safe technique and may prevent further deterioration in patients with acute exacerbations of COPD with mild respiratory acidosis.
Vargas
Frédéric
F
Département de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France. frederic.vargas@chu-bordeaux.fr
Bui
Hoang Nam
HN
Boyer
Alexandre
A
Salmi
Louis Rachid
LR
Gbikpi-Benissan
Georges
G
Guenard
Hervé
H
Gruson
Didier
D
Hilbert
Gilles
G
D000142:Acidosis, Respiratory / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D000368:Aged; D001774:Blood Chemical Analysis; D006801:Humans; D007902:Length of Stay; D009093:Mucus; D010102:Oxygen Inhalation Therapy; D010474:Percussion; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D015656:Respiratory Mechanics; D016896:Treatment Outcome