Domiciliary noninvasive positive pressure ventilation in chronic alveolar hypoventilation

Effectiveness of treatment with domiciliary nocturnal noninvasive positive pressure ventilation is analyzed in a group of patients with chronic alveol ar hypoventilation of different etiologies. It was applied with two levels of pressure (BiPAP) via nasal mask. Criteria for evaluation were symptomato logy and improvement in gas exchange. Data were analyzed by Student tests. A total of 13 patients were included, mean age 55.7 range 20 to 76 years (5 male 8 female). Main diagnosis was tuberculosis in 6, four of them having had surgical procedure (thoracoplasty 2, frenicectomy 1 and neumonectomy 1) , myopathy 3 (myasthenia gravis 1, muscular dystrophy 1 and diaphragmatic p aralysis 1), obesity-hypoventilation syndrome 1, escoliosis 1, bronchiectas is 1 and cystic fibrosis 1. These last two patients were on waiting list fo r lung transplantation. At the moment of consultation, the symptoms were: d ysnea 13/13 (100%), astenia 13/13 (100%), hypersomnolency 10/13 (77%), ceph alea 9/13 (69%), leg edema 6/13 (46%), loss of memory 6/13 (46%). Regarding gas exchange, they showed hypoxemia and hypercapnia. Mean follow up was of 2.2 years (range 6 months to 4 years). Within the year, all 13 patients be came less dyspneic. Astenia, hypersomnolency, cephalea, leg edema and memor y loss disappeared. Improvement in gas exchange was: PaO2/FiO(2) from 269 /- 65.4 (basal) to 336.7 +/- 75.3 postreatment (p = 0.0018). PaCO2 from 70. 77 +/- 25.48 mmHg (basal) to 46.77 +/- 8.14 mmHg (p = 0.0013). Ventilatory support was discontinued en 5 patients: three because of pneumonia requirin g intubation and conventional mechanical ventilation, two of them died and one is still with tracheostomy; One patient with bronchiectasis and one wit h cystic fibrosis were transplanted. The remaining eight patients are stabl e. in conclusion, chronic alveolar hypoventilation can be effectively treat ed with domiciliary nocturnal noninvasive ventilation. Long term improvemen t in symptomatology and arterial blood gases can be obtained without signif icant complications.