DOMICILIARY NOCTURNAL INTERMITTENT POSITIVE PRESSURE VENTILATION IN PATIENTS WITH RESPIRATORY-FAILURE DUE TO SEVERE COPD - LONG-TERM FOLLOW-UP AND EFFECT ON SURVIVAL

Background-There is increasing interest in the use of non-invasive noc turnal intermittent positive pressure ventilation (NIPPV) in the manag ement of patients with chronic hypercapnoeic (type II) respiratory fai lure. Although this treatment enables patients requiring mechanical ve ntilatory support to be treated more readily at home, few studies have been done to demonstrate its long term benefits in chronic obstructiv e pulmonary disease (COPD) and the application of NIPPV in these circu mstances remains controversial. Methods-Eleven patients in severe stab le chronic type II respiratory failure due to COPD who were unresponsi ve to conventional treatments experienced symptomatic hypercapnia when receiving sufficient supplementary oxygen to result in an arterial ox ygen saturation (Sao(2)) of >90%. They were assessed for treatment wit h NIPPV, and its effects were observed for over two years using arteri al blood gas tensions, spirometric parameters and body mass index (BMI ), survival, hospital admissions, use of general practitioner resource s, and patient satisfaction. Results-Hospital admissions and GP consul tations were halved after one year compared with the year before NIPPV and there was a sustained improvement in arterial blood gas tensions at 12 and 24 months when breathing air, despite progressive deteriorat ion in ventilatory function. BMI did not change during the period of o bservation. The median survival was 920 days, with no patient dying wi thin the first 500 days. Conclusions-Domiciliary NIPPV results in impr ovements in arterial blood gas tensions which are sustained after two years of treatment and reduces both hospital admissions and general pr actitioner visits by patients with severe COPD in hypercapnoeic respir atory failure. It is well tolerated and, although there was no control group, survival appears to be prolonged when these results are compar ed with those of the NOTT and MRC (LTOT) trials.