title: Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet.
abstract: OBJECTIVE
  To evaluate the effect of intrapulmonary percussive ventilation (IPV) by mouthpiece during noninvasive positive-pressure ventilation with helmet in patients with exacerbation of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  General intensive care unit, university hospital.
  
  
  METHODS
  Forty patients with exacerbation of COPD ventilated with noninvasive positive-pressure ventilation by helmet were randomized to two different mucus clearance strategies: IPV (IPV group) vs. respiratory physiotherapy (Phys group). As historical control group, 40 patients receiving noninvasive positive pressure and ventilated by face mask treated with respiratory physiotherapy were studied.
  
  
  METHODS
  Two daily sessions of IPV (IPV group) or conventional respiratory physiotherapy (Phys group).
  
  
  RESULTS
  Physiologic variables were measured at entry in the intensive care unit, before and after the first session of IPV, and at discharge from the intensive care unit. Outcome variables (need for intubation, ventilatory assistance, length of intensive care unit stay, and complications) were also measured. All physiologic variables improved after IPV. At discharge from the intensive care unit, Paco2 was lower in the IPV group compared with the Phys and control groups (mean +/- sd, 58 +/- 5.4 vs. 64 +/- 5.2 mm Hg, 67.4 +/- 4.2 mm Hg, p < .01). Pao2/Fio2 was higher in IPV (274 +/- 15) than the other groups (Phys, 218 +/- 34; control, 237 +/- 20; p < .01). In the IPV group, time of noninvasive ventilation (hrs) (median, 25th-75th percentile: 61, 60-71) and length of stay in the intensive care unit (days) (7, 6-8) were lower than other groups (Phys, 89, 82-96; control, 87, 75-91; p < .01; and Phys, 9, 8-9; control, 10, 9-11; p < .01).
  
  
  CONCLUSIONS
  IPV treatment was feasible for all patients. Noninvasive positive-pressure ventilation by helmet associated with IPV reduces the duration of ventilatory treatment and intensive care unit stay and improves gas exchange at discharge from intensive care unit in patients with severe exacerbation of COPD.
authors.affiliation: Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University School of Medicine, Trieste, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Antonaglia
authors.forename: Umberto
authors.initials: U
authors.lastname: Lucangelo
authors.forename: Walter A
authors.initials: WA
authors.lastname: Zin
authors.forename: Alberto
authors.initials: A
authors.lastname: Peratoner
authors.forename: Loredana
authors.initials: L
authors.lastname: De Simoni
authors.forename: Guido
authors.initials: G
authors.lastname: Capitanio
authors.forename: Sara
authors.initials: S
authors.lastname: Pascotto
authors.forename: Antonino
authors.initials: A
authors.lastname: Gullo
mesh_terms: D000208:Acute Disease; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation* / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008397:Masks; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods*; D016896:Treatment Outcome