LONG-TERM NASAL INTERMITTENT POSITIVE PRESSURE VENTILATION (NIPPV) IN16 CONSECUTIVE PATIENTS WITH BRONCHIECTASIS - A RETROSPECTIVE STUDY

Life expectancy and quality of life are poor in patients with chronic respiratory failure due to bronchiectasis. The indication for nocturna l nasal intermittent positive pressure ventilation (NIPPV) remains con troversial in chronic obstructive lung disease. The purpose of the pre sent study was to determine whether some of the objectives of home mec hanical ventilation, i.e. improvement in blood gas values and reduced length of hospitalization, were fulfilled by NIPPV and oxygen plus med ical treatment in patients with chronic respiratory failure due to bro nchiectasis. Sixteen consecutive patients (12 females and four males; mean age 57+/-11 yrs) with chronic respiratory failure due to bronchie ctasis, treated at home with nocturnal NIPPV in addition to oxygen the rapy, were retrospectively studied in terms of blood gas values and du ration of hospitalization before and after NIPPV. Details of the thera py received by each patient were recorded, Nine patients agreed to com plete a questionnaire to determine their perception of the benefits of the treatment, NIPPV was performed using a volumetric respirator and was applied with a customized nasal mask modelled with silicone paste. NIPPV was used for a mean of 26 months (range 0.5-60 months), Eleven patients were alive 12 months after use of NIPPV, No significant impro vement in blood gas values was noted on room air during NIPPV, but art erial carbon dioxide tension (Pa,CO2 stabilized after the period of wo rsening observed before initiation of NIPPV, Duration of hospitalizati on, the year before and the year after NIPPV, was 19 (3-40) and 16 (8- 37) days, respectively (Ns), For the 11 patients who were alive 2 yrs after the start of NIPPV, duration of hospitalization the year before NIPPV and between 12 and 24 months after NIPPV were 17 (4-40) and 7 (2 -27) days, respectively (p<0.05). Nine patients who had received NIPPV for at least 12 months at the time of the study reported an improveme nt in their quality of life. These results suggest that home ventilato ry support by nasal intermittent positive pressure ventilation offers an acceptable alternative to tracheotomy, with less discomfort, in the management of severe respiratory failure due to bronchiectasis, in or der to allow the patient to return home, These results should be confi rmed by controlled studies.