Noninvasive ventilation (Bi-Pap)

Noninvasive ventilation speeds recovery from COPD exacerbations

NEW YORK (Reuters Health) – Noninvasive positive pressure ventilation during acute exacerbations of chronic obstructive pulmonary disease (COPD) reduces the need for intubation and speeds recovery, according to a report in the September Journal of Critical Care.

In 75 patients hospitalized for acute exacerbation of COPD, Dr. Miguel Carrera from Hospital Universitario Son Dureta, Palma de Mallorca, Spain, and colleagues delivered controlled oxygen therapy using a bilevel positive airway pressure ventilator (BiPAP) that had been modified so it wouldn’t also provide inspiratory pressure support.

Respiratory rate improved faster in the BiPAP group than in the sham-BiPAP group, the authors report. In addition, only 13.5% of ventilated patients required intubation, compared with 34% of patients in the sham group.

The effect of BiPAP in reducing the need for intubation was even greater in patients whose arterial pH did not exceed 7.3. In this subset, 29% of treated patients and 71% of the sham group required intubation.

Arterial pH and arterial PaCO2 improved in both groups but to a greater extent in the BiPAP group, the researchers note. Average hospital length of stay was 10 days with treatment and 12 days without (p=0.06).

“These results demonstrate that noninvasive positive pressure ventilation…reduces the need for endotracheal intubation, particularly in the more severe patients, and leads to a faster recovery in patients with acute exacerbation of COPD,” the investigators conclude.

They caution, however, that their patients were in a dedicated pulmonary unit, and they add that the therapy they describe should be provided “in a controlled environment that facilitates close monitoring.”

J Crit Care 2009;24:473.e7-473.e14.

Copyright Reuters 2009.

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