Efficacy and Compliance With Noninvasive Positive Pressure Ventilation in Patients With Chronic Respiratory Failure: Acute Effects of NPPV

In: Respiratory Failure

11 Sep 2014

In all patients who started NPPV, 34 used BiPAP (15 with COPD, 19 with restrictive disorders) and 6 required a portable volume ventilator (5 with COPD, 1 with restrictive disorder) in order to achieve ventilation goals. The average level of inspiratory positive airway pressure was 17 ± 4 cm H2O, and expiratory positive airway pressure was 3 ± 2 cm H2O with a mean pressure boost of 14 ± 3 cm H2O. The average delivered expired Vt was 725 ± 140 mL with a rate of 22 ± 4 breaths/min in patients receiving NPPV via the portable volume ventilator.
Arterial blood gas analysis in all compliant patients was obtained while the patients were breathing spontaneously at the time of admission, while using NPPV at the optimum settings, during spontaneous breathing at discharge, and while spontaneously breathing at a follow-up visit approximately 23 ± 5 weeks after discharge, as shown in Figure 2. Mean Pa02/Fl02 values while using NPPV were higher than admission values (329 ± 17 vs 283 ± 13; p = 0.015); mean PaC02 was significantly lower during NPPV than at admission (51 ± 2 vs 67 ± 3 mm Hg; p = 0.0001); and pH was greater during NPPV than at admission (7.41 ± 0.01 vs 7.35 ± 0.01; p = 0.0001). In compliant patients, the improvements in gas exchange (327 ± 10 vs 283 ± 13; p = 0.01), Paco2 (52 ± 2 vs 67 ± 3; p = 0.0001), and pH 7.38 ± 0.01 vs 7.35 ± 0.01; p = 0.007) were maintained during spontaneous breathing, both at discharge and at follow-up (Fig 2). order birth control online

The functional scores in compliant patients were significantly improved at discharge compared with scores at admission (from 4.8 ± 0.2 to 2.7 ± 0.3 AUs; p < 0.001; Fig 3).
Long-term Effects of NPPV
Patients who remained compliant with NPPV were reexamined at follow-up visits at 23 ± 5 weeks to determine whether improvements in gas exchange were maintained. In comparison with values obtained during spontaneous breathing on admission improvements in Pa02/Fl02 (283 ± 13 vs 317 ± 10 p = 0.05), Paco2 (67 ± 3 vs 52 ± 2 mm Hg p = 0.001), and pH (7.35 ± 0.01 vs 7.38 ± 0.01 p = 0.03) were maintained (Fig 2).

Figure 2. Arterial blood gas results obtained in all compliant patients (n = 26) during spontaneous breathing on admission (ADMIT), at discharge from the Noninvasive Respiratory Care Unit (D/C), and at 6-month follow-up (F/U). NPPV represents arterial blood gases taken while receiving NPPV on optimum settings. After NPPV implementation, improvements in gas exchange were maintained during spontaneous breathing at discharge and at 6-month follow-up. p Values significantly different from admission (see text).

Figure 2. Arterial blood gas results obtained in all compliant patients (n = 26) during spontaneous breathing on admission (ADMIT), at discharge from the Noninvasive Respiratory Care Unit (D/C), and at 6-month follow-up (F/U). NPPV represents arterial blood gases taken while receiving NPPV on optimum settings. After NPPV implementation, improvements in gas exchange were maintained during spontaneous breathing at discharge and at 6-month follow-up. p Values significantly different from admission (see text).

Figure 3. Functional score in patients compliant with NPPV (n = 26) on admission (ADMIT), on discharge from the Ventilator Rehabilitation Unit (D/C), and at 3-, 6-, and 12-month follow-up visits after discharge. Compliant NPPV patients continued to show improvements in functional status during the follow-up period.

Figure 3. Functional score in patients compliant with NPPV (n = 26) on admission (ADMIT), on discharge from the Ventilator Rehabilitation Unit (D/C), and at 3-, 6-, and 12-month follow-up visits after discharge. Compliant NPPV patients continued to show improvements in functional status during the follow-up period.


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