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

In: Respiratory Failure

10 Sep 2014

Efficacy and Compliance With Noninvasive Positive Pressure Ventilation in Patients With Chronic Respiratory Failure: ResultsPatient Characteristics
Patient characteristics are shown in Table 2. An equal number of the 40 patients enrolled in the study had COPD or restrictive disorders as the primary process responsible for respiratory failure. Of the 20 patients with restrictive disorders, 5 had kyphoscoliosis, 6 had obesity hypoventilation syndrome, 6 had an underlying chronic neuromuscular disease, and 3 had fibrothorax. For the total group, the average age was 65 ± 9.7 years with a 3:1 female:male predominance. Sixteen of the 40 patients (40%) had evidence of cor pulmonale by echocardiography or clinical examination, and 13 of the 40 patients (33%) had required intubation and mechanical ventilation for respiratory failure in the preceding 6 months. birth control

Table 3 shows baseline gas exchange, respiratory mechanics and functional status in both patient groups. At baseline, both the COPD and restrictive-disorders patient subsets had severe derangement in lung mechanics (FVC, 1.82 ± 0.14 vs 1.17 ± 0.15 L, respectively; FEV1, 0.71 ± 0.1 vs 0.79 ± 0.1 L, respectively). Furthermore, Plmax (32 ± 4 vs 36 ± 4 cm H2O), PEmax (50 ± 24 vs 50 ± 9 cm H2O), Pao2/Fio2 (255 ± 16 vs 287 ± 18), and functional scores (3.3 ± 0.4 vs 3.1 ± 0.4 AUs) were similarly abnormal in both COPD and restrictive patients, respectively. Both patient groups had evidence of hypercapnic respiratory failure (PaC02 70 ± 3 mm Hg in COPD patients vs 62 ± 3 mm Hg in those with restrictive disorders; p = 0.07), but COPD patients were more hypercapnic and had significantly lower pH values (7.33 ± 0.01 vs 7.37 ± 0.01; p = 0.02).
Acute Effects of NPPV
Of the 40 patients admitted into the study, 4 (1 with restrictive disorder, 3 with COPD) discontinued NPPV prior to hospital discharge; thus, 36 of 40 (90%) were discharged home while using nightly NPPV. During the next 23 ± 5 weeks, another 10 patients (3 with restrictive disorders, 7 with COPD) discontinued NPPV (Fig 1).
Table 2—General Characteristics in All Patients (n = 40)

Etiology of Respiratory Failure
Age, yr 65 ± 9.7
Sex
Female 29
Male 11
Presence of cor pulmonale 16/40 (40%)
Intubation < 6 mo prior to evaluation 13/40(33%)

Table 3—Baseline Gas Exchange, Respiratory Mechanics, and Functional Status

RestrictiveDisorders COPD
Gas exchange
Pao2/Flo2 287 ± 18 255 ± 16
Paco2 62 ± 3 70 ± 3*
ph 7.37 ± 0.01 7.33 ± 0.01*
Respiratory mechanics
FVC, L 1.17 ± 0.15 1.82 ± 0.14*
FEV1, L 0.79 ± 0.1 0.71 ± 0.1
PImax, cm H2O 36 ± 4 32 ± 4
PEmax, cm H2O 50 ± 9 50 ± 4
Functional status 3.1 ± 0.4 3.3 ± 0.4

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