Intensive Care Medicine

, Volume 26, Issue 12, pp 1764–1772

Continuous positive airway pressure facilitates spontaneous breathing in weaning chronic obstructive pulmonary disease patients by improving breathing pattern and gas exchange

  • Hajo K. Reissmann
  • V. Marco Ranieri
  • Peter Goldberg
  • Stewart B. Gottfried
Original

DOI: 10.1007/s001340000725

Cite this article as:
Reissmann, H., Ranieri, V., Goldberg, P. et al. Intensive Care Med (2000) 26: 1764. doi:10.1007/s001340000725

Abstract.

Objective: To elucidate the effects of continuous positive airway pressure (CPAP) on breathing pattern, gas exchange and the ability to sustain spontaneous breathing (SB) in chronic obstructive pulmonary disease (COPD) patients with dynamic hyperinflation. Design: Prospective study with two randomised trials of SB without and with CPAP in each patient. Setting: Medical intensive care units (ICUs) in two university hospitals. Patients: Nine dynamically hyperinflated, intubated COPD patients recuperating from acute exacerbation. Interventions: One SB trial with CPAP (5–7.5 cmH2O), one without (control) in each patient . Measurements: airway opening pressure, gas flow and thus breathing pattern, oxygen uptake, carbon dioxide excretion, arterial blood gases, dyspnoea and respiratory drive (P100). Results: With CPAP, intrinsic positive end-expiratory pressure (PEEPi) fell from 11.4 to 6.3 cmH2O (p<0.05). Eight patients sustained SB with CPAP for the maximum time planned (30 min), one failed after 18 min. In contrast, only four patients successfully completed the control trial, the others failing after 5–18 min (p<0.05). Dyspnoea – gauged on a visual analogue scale by five patients – was less severe or occurred later with CPAP. Breathing with CPAP tended to be slower (18.9 vs 22.2 min–1, p<0.05) and deeper (tidal volume 370 vs 323 ml). At the end of the control run, PaCO2 was higher (60 vs 55 mmHg, p<0.05) and still rising while being stable at the end of the CPAP trial. Conclusion: CPAP helps severely ill COPD patients sustain SB. Apparently it does so by promoting slower, deeper breathing and thus facilitating carbon dioxide elimination.

Chronic obstructive pulmonary disease Dynamic hyperinflation Spontaneous breathing Continuous positive airway pressure Weaning Intrinsic positive end-expiratory pressure (PEEPi) 

Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • Hajo K. Reissmann
    • 1
  • V. Marco Ranieri
    • 2
  • Peter Goldberg
    • 3
  • Stewart B. Gottfried
    • 4
  1. 1.Department of Anaesthesiology, University Hospital Eppendorf, Martinistrasse 52, 20246 HamburgGermany
  2. 2.Department of Surgery, Anaesthesia and Intensive Care, University of Pisa, PisaItaly
  3. 3.Division of Critical Care Medicine, McGill University Medical Centre, McGill University, Montreal, QuebecCanada
  4. 4.Divisions of Respiratory and Critical Care Medicine, McGill University Medical Centre, and Meakins-Christie Laboratories, McGill University, Montreal, QuebecCanada