Several studies have shown that noninvasive positive pressure ventilation (NPPV) can acutely improve gas exchange and sleep quality. However, reports describing the chronic effects of NPPV on gas exchange, respiratory mechanics, and functional status are limited and contradictory. This is even more problematic in patients with chronic respiratory failure related to COPD, in whom conflicting results regarding the beneficial effects of long-term NPPV application have been described.- Moreover, few data exist describing long-term compliance with NPPV and the needs for adjustment of chronic outpatient NPPV care (ie, changes in face mask or ventilator settings) to ensure patient compliance with chronic NPPV therapy. there
In this study we evaluated the acute and chronic effects of NPPV on gas exchange, functional status, and respiratory mechanics in patients with chronic respiratory failure related to COPD or restrictive ventilatory disorders. We also sought to determine the incidence and type of problems that arise with long-term outpatient NPPV therapy so that these problems could be ameliorated in the future to improve long-term compliance. We initiated NPPV in a noninvasive respiratory care unit geared toward the evaluation and treatment of NPPV and followed patients after discharge in a comprehensive outpatient program in order to maximize compliance with chronic NPPV therapy.
Materials and Methods
Forty consecutive patients were admitted to the Ventilator Rehabilitation Unit (VRU) at Temple University Hospital for evaluation and treatment of chronic respiratory failure. Prior to VRU admission and enrollment into the study, all patients were treated at least 48 h with maximally effective doses of inhaled bronchodilators (eg, ^-agonist and anticholinergic agents), systemic and/or inhaled corticosteroids, supplemental oxygen and, on occasion, theophylline. Following maximization of medical therapy, patients enrolled into the study fulfilled at least two of the clinical and two of the physiologic criteria listed in Table 1 before implementation of noninvasive ventilation.
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