Nasal ventilation in COPD exacerbations: early and late results of a prospective, controlled study

Noninvasive positive pressure mechanical ventilation (NIPPV) in exacerbated chronic obstructive pulmonary disease (COPD) has been investigated early a nd after 1 yr of follow-up. To this end, 30 patients were enrolled in a prospective, controlled trial: 15 had early administration of NIPPV (Group A), 15 had medical therapy only (Group B); assignment was made on the basis of equipment availability only . In-hospital mortality, need for endotracheal intubation and mean length of hospitalization were lower in Group A, though the difference was not statis tically significant. Arterial oxygen tension in arterial blood (Pa,O-2), ca rbon dioxide tension in arterial blood (Pa,CO2) and HCO3- improved signific antly in both groups from admission to discharge: 45.8+/-8.6 versus 64.9+/- 10.0; 59.4+/-11.8 versus 48.6+/-7.3; 34.3+/-4.3 versus 30.1+/-3.4 in group A; 49.2+/-11.4 versus 60.9+/-8.2; 52.6+/-15.9 versus 44.4+/-8.7; 31.7+/-5.9 versus 28.0+/-3.6 in group B, respectively, p<0.05 for all comparisons; pH , percentage forced expiratory volume in one second (FEV1) and tidal volume (VT) improved significantly in patients of group A only: 7.36+/-0.04 versu s 7.41+/-0.02; 39.8+/-13.6 versus 49.4+/-11.7; 0.71+/-0.3 versus 0.84+/-0.4 , respectively, p<0.05. During follow-up, 3, 6, and 12 months survival rate s were significantly higher in Group A than in Group B (p<0.02). Hospital n ew admissions over 1 yr were more frequent in Group B (n=6, incidence rate: 0.216%) than in Group A (n=4, incidence rate: 0.084%). Therefore, noninvasive positive pressure mechanical ventilation may be adde d to "conventional" medical therapy in exacerbated chronic obstructive pulm onary disease.