Chronic obstructive pulmonary disease NIPPV

Figure 2 Comparison of Medical Research Council Shrat Form Questionnaire (SFag) scores in hypoxic patients and in patients on NIPPV. Positive values indicate a worse quaUty of hfe in the NIPPV group. Abbreviations COPD, chronic obstructive pulmonary disease NIPPV, noninvasive positive pressure ventilation. Source Modified from Ref. 26.

Chronic ventilatory support is currently a well-accepted therapy in patients with chronic respiratory failure due to thoracic cage abnormalities or in patients with neuromuscular disease. In contrast, the evidence to use chronic ventilatory support in patients with obstructive lung disease is less clear. Most of studies in this area have been in patients with chronic obstructive pulmonary disease (COPD) and only a few in patients wiA cystic fibrosis (CF) and bronchiectasis. In this chapter, we will focus primarily on COPD, discussing first the rationale of noninvasive positive pressure ventilation (NIPPV) in these patients and second all randomized controlled studies. Thereafter, we will elaborate on different issues that might be important in making NIPPV more effective in patients with COPD. Finally, we will discuss the effeets of ehronie ventilatory support in patients with CF and bronchiectasis. 

A 53-year-old woman with severe chronic obstructive pulmonary disease, on home oxygen, had been admitted to the ICU on three occasions in 2003, for acute respiratory failure consequent upon an acute exacerbation, always unresponsive with a Glasgow Coma Scale 8/15 (Table 9). She received noninvasive positive pressure ventilation (NIPPV) by mask on each admission and after 24 hours had greatly improved. On each occasion, her LOS was 17 days before discharge home, representing acute care cost of 8880 (seven days ICU = 6300 plus 10 days ward = 2580, for a total of 8880 per admission). 

By 1994, fees paid by medical insurance increased to cover medical services provided by the hospital, clinic, or home care nurse as well as the costs of medical equipment, such as the ventilator rental. This led to rapid growth in the population of patients receiving HMV (2). In April 1995, of the 536 HMV cases 65% had NMD, 20% had parenchymal disease (PD), such as sequelae of tuberculosis and chronic obstructive pulmonary disease (COPD), and 15% had thoracic restriction or central hypoventilation syndrome (3,4). In June 1995, of the 1006 patients undergoing LTV for at least three months, 215 (21%) could have been discharged to a home care setting if an appropriate public assistance program had been established (3,4). By January 1997, there were 1250 patients receiving HMV of whom 461 (1.2 people/million) used noninvasive positive pressure ventilation (NIPPV) (5). 

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