Nasal intermittent positive pressure

Pieters T, Amy JJ, Burrini D, Aubert G, Rodenstein DO, Collard Ph. Normal pregnancy in primary alveolar hypoventilation treated with nocturnal nasal intermittent positive pressure ventilation. Eur Respir J 1995 8 1424—1427. 

Simonds AK, Elliott MW. Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders. Thorax 1995 50(6) 604-609. 

Leger P, Bedicam JM, Comette A, et al. Nasal intermittent positive pressure ventilation. Longterm follow-up in patients with severe chronic respiratory insufficiency. Chest 1994 105(1) 100-105. 

Vianello A, Bevilacqua M, Salvador V, et al. Long-term nasal intermittent positive pressure ventilation in advanced Duchenne s muscular dystrophy. Chest 1994 105(2) 445 148. 

Elliott MW, Simonds AK, Carroll MP, et al. Domiciliary nocturnal nasal intermittent positive pressure ventilation in hypercapnic respiratory failure due to chronic obstructive lung disease effects on sleep and quality of life. Thorax 1992 47(5) 342-348. 

Restrick LJ, Fox NC, Braid G, et al. Comparison of nasal pressure support ventilation with nasal intermittent positive pressure ventilation in patients with nocturnal hypoventilation. Eur... 

Simonds and Elliott (9) studied patients with CRF caused by either obstructive or restrictive diseases who required night nasal intermittent positive pressure ventilation (NIPPV). The results, summarized in Figure 1, illustrate that the NIPPV group had a significantly higher impairment in physical function compared to patients with other chronic diseases. General health and mental health were similar to those of patients with other chronic diseases, while physical role limitation and pain were less impaired than in other chronic diseases. Mental health was similar to that of normal subjects. 

Figure 5 Change in SGRQ scores after six months of nasal intermittent positive pressure ventilation. Abbreviation SGRQ, St. George s Respiratory Questionnaire. Source Modified from Ref. 19.

Perrin C, El Far Y, Vandenbos F, et al. Domiciliary nasal intermittent positive pressure ventilation in severe COPD effects on lung function and quality of life. Eur Respir J 1997 10 2835-2839. 

Bi-level NIV may be used as a first-line treatment, with supplemental oxygen (27). Expiratory airway pressure is titrated to control h5q)opneas and apneas, and inspiratory airway pressure is added to control Paco2. If bi-level NIV fails, nasal volume ventilation may be used (29). In many patients with OHS and predominant OSA, once hypercapnia has improved (which may take several weeks) nCPAP may be used (29). Thirteen obese patients (n = 13) with a BMI > 35, aged 28-69 years with severe OSAS and hypercapnia (8.2 0.3 kPa) and failing to respond to initial CPAP therapy, were treated via a nasal nocturnal volume-cycled ventilator, which was tolerated by all patients. Significant improvements in daytime arterial blood gas levels were obtained after 7 to 18 days of nasal intermittent positive pressure ventilation (29) in 10 of the 13 patients three months later, 12 of the 13 patients could be converted to nCPAP therapy and one patient remained on NIV. In another study (37), the same results were observed after three months of home nocturnal bi-level NIV in seven patients, three of whom had severe obesity. 

Perez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest 2005 128 587-594. 

Waldhom RE. Nocturnal nasal intermittent positive pressure ventilation with bi-level airway pressure (BIPAP) in respiratory failure. Chest 1992 101 516-521. 

Cazzolli PA, Oppenheimer EA. Home mechanical ventilation for amyotrophic lateral sclerosis nasal compared to tracheostomy-intermittent positive pressure ventilation. J Neurol Sci 1996 139(suppl) 123-128. 

Cazzolli PA, Oppenheimer EA. Home mechanical ventilation for motor neuron disease (MND/ ALS) nasal compared to tracheostomy intermittent positive pressure ventilation (IPPV). Abstracts of Papers, 6th Intemational Symposium on ALS/MND, Dublin, Ireland, November 17-19, 1995. Moss AH, Oppenheimer EA, Casey P, et al. Patients with amyotrophic lateral sclerosis receiving long-term mechanical ventilation advance care planning and outcomes. Chest 1996 110 249-255. 

Bach JR, Alba A, Mosher R, et al. Intermittent positive pressure ventilation via nasal access in the management of respiratory insufficiency. Chest 1987 94 168-170. 

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