Domiciliary nocturnal intermittent positive pressure ventilationin patients with respiratory failure due to severe COPD: long termfollow up and effect on survival

BACKGROUND—There is increasing interest in the useof non-invasive nocturnal intermittent positive pressure ventilation(NIPPV) in the management of patients with chronic hypercapnoeic (typeII) respiratory failure. Although this treatment enables patientsrequiring mechanical ventilatory support to be treated more readily athome, few studies have been done to demonstrate its long term benefitsin chronic obstructive pulmonary disease (COPD) and the application ofNIPPV in these circumstances remains controversial.
METHODS—Eleven patients in severe stable chronictype II respiratory failure due to COPD who were unresponsive toconventional treatments experienced symptomatic hypercapnia whenreceiving sufficient supplementary oxygen to result in an arterialoxygen saturation (SaO₂) of >90%. They wereassessed for treatment with NIPPV, and its effects were observed forover two years using arterial blood gas tensions, spirometricparameters and body mass index (BMI), survival, hospital admissions,use of general practitioner resources, and patient satisfaction.
RESULTS—Hospital admissions and GP consultationswere halved after one year compared with the year before NIPPV andthere was a sustained improvement in arterial blood gas tensions at 12 and 24 months when breathing air, despite progressive deterioration inventilatory function. BMI did not change during the period ofobservation. The median survival was 920 days, with no patient dyingwithin the first 500days.
CONCLUSIONS—Domiciliary NIPPV results inimprovements in arterial blood gas tensions which are sustained aftertwo years of treatment and reduces both hospital admissions and generalpractitioner visits by patients with severe COPD in hypercapnoeicrespiratory failure. It is well tolerated and, although there was nocontrol group, survival appears to be prolonged when these results are compared with those of the NOTT and MRC (LTOT) trials.