NONINVASIVE PRESSURE SUPPORT VENTILATION IN COPD PATIENTS WITH POSTEXTUBATION HYPERCAPNIC RESPIRATORY INSUFFICIENCY

Patients with chronic obstructive pulmonary disease (COPD) who have be en intubated and mechanically ventilated may prove difficult to wean, Noninvasive ventilation may be used in an attempt to avoid new endotra cheal intubation, The efficacy of administration of noninvasive pressu re support ventilation was evaluated in 30 COPD patients with postextu bation hypercapnic respiratory insufficiency, compared with 30 histori cally matched control patients who were treated conventionally, Patien ts were included in the study if, within 72 h postextubation, they pre sented with respiratory distress, defined as the combination of a resp iratory frequency >25 breaths.min(-1), an increase in the arterial car bon dioxide tension (Pa,CO2) of at least 20 % compared with the value measured after extubation, and a pH <7.35, Noninvasive pressure suppor t ventilation was effective in correcting gas exchange abnormalities, The use of noninvasive ventilation significantly reduced the need for endotracheal intubation: 20 of the 30 patients (67%) in the control gr oup required endotracheal intubation, compared with only six of the 30 patients (20%) in the noninvasive-ventilation group (p<0.001). In-hos pital mortality was not significantly different between the two groups , but the mean duration of ventilatory assistance for the treatment of the postextubation distress, and the length of intensive care unit st ay related to this event, were both significantly shortened by noninva sive ventilation (p<0.01), In conclusion, noninvasive ventilation may be used in the management of patients with chronic obstructive pulmona ry disease and postextubation hypercapnic respiratory insufficiency.