title: Update: Non-Invasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to COPD.
abstract: Long-term non-invasive positive pressure ventilation (NPPV) has widely been accepted to treat chronic hypercapnic respiratory failure arising from different etiologies. Although the survival benefits provided by long-term NPPV in individuals with restrictive thoracic disorders or stable, slowly-progressing neuromuscular disorders are overwhelming, the benefits provided by long-term NPPV in patients with chronic obstructive pulmonary disease (COPD) remain under question, due to a lack of convincing evidence in the literature. In addition, long-term NPPV reportedly failed in the classic trials to improve important physiological parameters such as arterial blood gases, which might serve as an explanation as to why long-term NPPV has not been shown to substantially impact on survival. However, high intensity NPPV (HI-NPPV) using controlled NPPV with the highest possible inspiratory pressures tolerated by the patient has recently been described as a new and promising approach that is well-tolerated and is also capable of improving important physiological parameters such as arterial blood gases and lung function. This clearly contrasts with the conventional approach of low-intensity NPPV (LI-NPPV) that uses considerably lower inspiratory pressures with assisted forms of NPPV. Importantly, HI-NPPV was very recently shown to be superior to LI-NPPV in terms of improved overnight blood gases, and was also better tolerated than LI-NPPV. Furthermore, HI-NPPV, but not LI-NPPV, improved dyspnea, lung function and disease-specific aspects of health-related quality of life. A recent study showed that long-term treatment with NPPV with increased ventilatory pressures that reduced hypercapnia was associated with significant and sustained improvements in overall mortality. Thus, long-term NPPV seems to offer important benefits in this patient group, but the treatment success might be dependent on effective ventilatory strategies.
authors.affiliation: a Department of Pulmonary Sleep and Critical Care , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA.
authors.forename: Nejat
authors.initials: N
authors.lastname: Altintas
mesh_terms: D001784:Blood Gas Analysis; D002908:Chronic Disease; D004417:Dyspnea / Q000628:therapy; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D063087:Noninvasive Ventilation / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: chronic obstructive pulmonary disease; chronic respiratory failure; hypercapnia; non-invasive positive pressure ventilation; systematic review