Efficacy and Compliance With Noninvasive Positive Pressure Ventilation in Patients With Chronic Respiratory Failure: Discussion

In: Respiratory Failure

13 Sep 2014

Our data show that in moderately ill patients with chronic respiratory failure, NPPV was associated with acute and chronic improvements in gas exchange and functional status. In contrast, chronic NPPV was not associated with an improvement in spirometry or respiratory muscle strength. Despite enrollment in a comprehensive program (with both inpatient and outpatient components), only 65% of patients continued to use NPPV on a chronic basis, Only half of the patients with severe COPD and hypercapnic respiratory failure continued to chronically use NPPV therapy, whereas 16 of 20 patients (80%) with restrictive disorders remained compliant with NPPV. Minor complications and changes in gas exchange necessitated frequent adjustments in face mask or ventilator settings to maintain effectiveness and compliance with outpatient therapy. add comment

Based on the data, we suggest that comprehensive follow-up is needed to correct equipment problems and maximize patient compliance with NPPV therapy.
Our observations that NPPV improves gas exchange and functional status in patients with restrictive ventilatory disorders corroborate the findings of others. As a whole, when noninvasive ventilation is used in patients with restrictive ventilatory disorders, the data uniformly show an improvement in patient symptoms and gas exchange, and occasionally demonstrate an improvement in respiratory muscle function and spirometric values. Although NPPV improves gas exchange and symptoms in patients with restrictive ventilatory disorders, its effect on respiratory muscle strength and spirometry is variable. Our findings are in agreement with those of others that improvements in gas exchange and functional status need not be accompanied by any change in spirometry or respiratory muscle strength.
Results of noninvasive ventilation in COPD patients with chronic respiratory failure have been even more inconsistent. Strumpf et al and Gay et al have shown that NPPV in patients with chronic, stable, moderately severe COPD has no significant effect on gas exchange, functional status, or the patients’ quality of life. In contrast, other investigators have demonstrated that NPPV used daily for 1 week to 3 months had significant beneficial effects on gas exchange, sleep quality, exercise tolerance, and quality of life.

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