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Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease

BMJ 1997; 314 doi: (Published 18 January 1997) Cite this as: BMJ 1997;314:163

Use it sooner rather than later to assist the “respiratory muscle pump”

  1. David R Baldwin, Consultant physiciana,
  2. Martin B Allen, Consultant physicianb
  1. a Department of Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB
  2. b Sleep and Ventilation Centre, Department of Respiratory Medicine, City General Hospital, Stoke on Trent ST4 6QG

    Between a fifth and a third of patients admitted to hospital with hypercapnic respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease will die in hospital, despite selective use of mechanical ventilation. 1 2 3 4 5 6 7 8 9 10 11 12 13 In severe chronic obstructive pulmonary disease, hyperinflation places the respiratory muscles at a mechanical disadvantage and they function close to their maximum capacity.14 15 During acute exacerbations, elastic and resistive loads on the respiratory muscles increase and may lead to ventilatory failure. The ensuing tissue acidosis further impairs respiratory muscle function, producing a vicious cycle.16 Thus a logical approach is to assist the compromised “respiratory muscle pump”.

    Non-invasive positive pressure ventilation (NIPPV) employs a nasal or full face mask to administer ventilatory support from a flow generator and is established in the treatment of patients with a variety of chronic hypoventilatory syndromes. A role in acute exacerbation of chronic obstructive pulmonary disease (COPD) was suggested by early open and case control studies9 10 11 and has recently been confirmed by three randomised controlled trials (see 1).5 6 7

    View this table:
    Table 1

    Randomised controlled trials of NIPPV …

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