NONINVASIVE MECHANICAL VENTILATION IMPROVES THE IMMEDIATE AND LONG-TERM OUTCOME OF COPD PATIENTS WITH ACUTE RESPIRATORY-FAILURE

Noninvasive positive pressure ventilation (NPPV) has been proposed in COPD patients with acute on chronic respiratory failure (ACRF) in orde r to avoid endotracheal intubation and to improve immediate outcome, b ut long-term outcome of this therapeutic approach is still undefined. We evaluated short- and long-term (1 year) outcome of early administra tion of NPPV in 24 patients with ACRF due to exacerbated COPD (Group A ) in comparison with 24 matched historical-control patients treated co nventionally (Group B). Patients of Group A were initially treated wit h NPPV via nasal mask in the presence of pH less than or equal to 7.32 , and/or Pa,o(2)<7.98 kPa, and/or Pa,CO2>7.18 kPa, plus signs of respi ratory distress. In-hospital survival rate was not significantly diffe rent in Group A vs Group B, but the patients treated with NPPV showed an earlier improvement in blood gases and a better pH and respiratory rate at discharge, Only 2 patients of Group A needed endotracheal intu bation as compared with 9 of Group B, Hospital stay was significantly reduced in survivors of Group A vs Group B, Further severe relapses of ACRF in Group A were treated using NPPV. The number and length of fur ther hospitalizations for pulmonary exacerbations were significantly h igher in Group B compared with Group A. The survival rate at 12 months was significantly lower in Group B than in Group A (50% vs 71%). In c onclusion, NPPV administration in patients with ACRF due to exacerbate d COPD improves not only immediate but also long-term outcome. (C)ERS Journals Ltd 1996.