Nocturnal nasal intermittent positive pressure ventilation (NIPPV) therapyfor chronic respiratory failure: long term effects

The development of positive pressure ventilation delivered through a nasal or face mask has greatly expanded the use of noninvasive ventilation in pat ients with chronic respiratory insufficiency, particularly during sleep. Di sorders ranging from neurologic and neuromuscular, such as polio and muscul ar dystrophy, central alveolar hypoventilation, thoracic cage disorders suc h as kyphoscoliosis, and pulmonary disorders such as COPD, particularly of the blue-bloater type. The relative hypoventilation that is common to each condition is due to varying combinations of an inadequate respiratory drive and an increase in the work of breathing. Previous studies have shown sust ained reversal of awake hypercapnia in patients with alveolar hypoventilati on syndrome using nocturnal NIPPV. We analysed 10 consecutive patients with chronic respiratory insufficiency due to diverse aetiologies over a period of time using long-term domiciliary nocturnal NIPPV. Awake hypercapnia and hypoxaemia improved in nine patients over time and de teriorated in one patient. There was no significant change in pulmonary fun ction apart from one patient with progressive muscular dystrophy who deteri orated. A considerable reduction in the need for subsequent hospital admiss ion was noted in the group as a whole following institution of NIPPV. We co nclude that nocturnal NIPPV improves awake gas exchange in patients with ch ronic respiratory failure.