Intensive Care Medicine

, Volume 19, Issue 8, pp 450–455

Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients

  • M. Vitacca
  • F. Rubini
  • K. Foglio
  • S. Scalvini
  • S. Nava
  • N. Ambrosino
Originals

DOI: 10.1007/BF01711086

Cite this article as:
Vitacca, M., Rubini, F., Foglio, K. et al. Intensive Care Med (1993) 19: 450. doi:10.1007/BF01711086

Abstract

Objective

1) To compare the clinical usefulness of both non-invasive pressure support ventilation (NPSV) and non-invasive intermittent positive pressure ventilation in assist-control (A/C) mode (NIPPV) in chronic obstructive lung disease (COLD) patients with acute hypercapnic respiratory failure: 2) to compare retrospectively the usefulness of non-invasive mechanical ventilation (NMV) with standard medical therapy alone.

Design

Prospective randomized retrospective study.

Setting

2 Respiratory intermediate intensive units.

Patients

29 COLD patients (age: 62±8 years) with chronic respiratory failure were hospitalized in a department for rehabilitation during acute relapses of their disease. They were transferred to our intermediate intensive care unit (IICU) and submitted randomly to either NPSV (16 patients) or NIPPV (13 patients).

Measurements and results

Blood gas analysis, dynamic flows, clinical variables, success rate, time of ventilation, side effects and subjective score of compliance to therapy. Therapy was considered successful when endotracheal intubation was avoided and patients were returned to their condition prior to exacerbation. No statistically significant difference was found between NPSV and NIPPV in success rate (NPSV 87.5%; NIPPV 57%) or in time of ventilation (NPSV: 69±49; NIPPV: 57±49 h). A better compliance to non-invasive mechanical ventilation (NMV) was found in NPSV patients than in NIPPV patients; side effects were observed less frequently in the NPSV group. Comparison of the success rate of NMV was retrospectively performed with 35 control COLD patients with chronic respiratory insufficiency who had undergone an acute relapse of their disease in the 2 years preceding the institution of the IICU and had been treated with oxygen and medical therapy alone. Patients submitted to NMV showed a greater success rate than control (82 versus 54%) after a period of ventilation ranging from 4–216 h.

Conclusion

Non-invasive mechanical ventilation performed either by NPSV or NIPPV may improve the outcome of acute exacerbations of COLD, as compared to medical therapy alone. NPSV seems to be more acceptable to patients in comparison with NIPPV.

Key words

Acute respiratory failure Mechanical ventilation Intermediate intensive care unit 

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • M. Vitacca
    • 1
  • F. Rubini
    • 2
  • K. Foglio
    • 1
  • S. Scalvini
    • 1
  • S. Nava
    • 2
  • N. Ambrosino
    • 2
  1. 1.Department of Medical Rehabilitation, Cardiorespiratory DivisionFondazione Clinica del Lavoro Pavia IRCCSGussago (BS)Italy
  2. 2.Department of Pulmonary RehabilitationMontescano (PV)Italy

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