Bi-level positive airway pressure ventilation for patients with stable hypercapnic chronic obstructive pulmonary disease

Abstract

Background: The role of noninvasive positive pressure ventilation (NPPV) has been well established in the treatment of acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD), however, its benefits in clinically stable hypercapnic COPD patients still not well known, so this trial aimed to assess the efficacy of NPPV in patients with stable hypercapnic COPD. Patients and methods: This study included 30 stable hypercapnic COPD patients hospitalized for long term stay from June 2012 to May 2014. The 30 patients who met the study criteria were randomized into the control group (15 patients: 13 males and 2 females with mean age 66 ± 6.2) maintained on standard treatment and the second group (15 patients: 12 males and 3 females with mean age 65 ± 7.3) received bi-level positive pressure ventilation added to their standard treatment after giving a written consent. The patients were evaluated and followed up after initiating this therapy. Results: After 6 months of NPPV, daytime PaCO2 (mmHg) during spontaneous breathing decreased from 55.2 ± 6.7 to 47.1 ± 3.1 mmHg and daytime PaO2 (mmHg) on room air increased from 48 ± 6.1 to 55.1 ± 8.3 with improvement of dyspnea scale and quality of life parameters. This was achieved with mean inspiratory pressures of 19.7 ± 2.41 cm H2O and mean expiratory pressures of 6.8 ± 1.7 cm H2O. Conclusions: NPPV is well tolerated and can improve blood gas levels, dyspnea and quality of life parameters in patients with stable hypercapnic COPD.

Keywords

• COPD
• Bi-level positive airway pressure
• Respiratory failure