NASAL INTERMITTENT POSITIVE PRESSURE VENTILATION - LONG-TERM FOLLOW-UP IN PATIENTS WITH SEVERE CHRONIC RESPIRATORY INSUFFICIENCY

Prior studies have shown that nasal intermittent positive pressure ven tilation (NIPPV) can improve arterial blood gas values, prevent sympto ms resulting from alveolar hypoventilation, and decrease hospitalizati on in patients with chronic respiratory failure. Most studies have inv olved small samples of patients followed up for a limited time. This s tudy reviews our experience during 5 years use of NIPPV in 276 patient s with kyphoscoliosis, posttuberculosis sequelae, Duchenne-type muscul ar dystrophy, COPD, and bronchiectasis followed up for greater than or equal to 3 years while receiving NIPPV. Outcomes were compared for pa tients who survived short term, eg, died or converted to management wi th a tracheostomy and intermittent positive ventilation (TIPPV) during year 1 or year 2 on a regimen of NIPPV and long term, eg, survived mo re greater than or equal to 2 years on a regimen of NIPPV. The most fa vorable outcome was achieved by patients with kyphoscoliosis and postt uberculous sequelae with improvement in PaO2 and PaCO2 (p<0.0001) and a reduction in days of hospitalization for respiratory illness (p<0.00 01) for greater than or equal to 2 years while receiving NIPPV. Patien ts with Duchenne-type muscular dystrophy also had fewer hospital days during NIPPV (p<0.003) but only 9 of 16 patients (56 percent) continue d using NIPPV for the duration of follow-up. Benefit was also more sho rt term for patients with COPD and bronchiectasis. NIPPV can sustain i mprovement in gas exchange, while reducing hospitalization for substan tial periods of time. NIPPV can be an attractive and effective alterna tive to other methods of assisted ventilation such as TIPPV.