High-intensity non-invasive positive pressure ventilation for stable hypercapnic COPD.
BACKGROUND
The objective of the present analysis is to describe the outcomes of high-intensity non-invasive positive pressure ventilation (NPPV) aimed at maximally decreasing PaCO(2) as an alternative to conventional NPPV with lower ventilator settings in stable hypercapnic COPD patients.


METHODS
Physiological parameters, exacerbation rates and long-term survival were assessed in 73 COPD patients (mean FEV(1) 30+/-12 %predicted) who were established on high-intensity NPPV due to chronic hypercapnic respiratory failure between March 1997 and May 2006.


RESULTS
Controlled NPPV with breathing frequencies of 21+/-3 breath/min and mean inspiratory/expiratory positive airway pressures of 28+/-5/5+/-1 cmH(2)O led to significant improvements in blood gases, lung function and hematocrit after two months. Only sixteen patients (22%) required hospitalisation due to exacerbation during the first year, with anaemia increasing the risk for exacerbation. Two- and five-year survival rates of all patients were 82% and 58%, respectively. The five year survival rate was 32% and 83% in patients with low (< or =39%) and high (> or =55%) hematocrit, respectively.


CONCLUSIONS
High-intensity NPPV improves blood gases, lung function and hematocrit, and is also associated with low exacerbation rates and a favourable long-term outcome. The current report strongly emphasises the need for randomised controlled trials evaluating the role of high-intensity NPPV in stable hypercapnic COPD patients.
Windisch
Wolfram
W
Department of Pneumology, University Hospital Freiburg, Germany.
Haenel
Moritz
M
Storre
Jan H
JH
Dreher
Michael
M
D000368:Aged; D002245:Carbon Dioxide / Q000097:blood* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000150:complications / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D012119:Respiration; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
D006454:Hemoglobins; D002245:Carbon Dioxide