Nasal positive pressure ventilation

Lin CC. Comparison between nocturnal nasal positive pressure ventilation combined with oxygen therapy and oxygen monotherapy in patients with severe COPD. Am J Respir Crit Care Med 1996 154 353-358. 

Casanova C, Celli BR, Tost L, et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest 2000 118 1582-1590. 

Goodenberger DM, Couser JI Jr., May JJ. Successful discontinuation of ventilation via tracheostomy by substitution of nasal positive pressure ventilation. Chest 1992 102(4) 1277-1279. 

Shivaram U, Cash ME, Beal A. Nasal continuous positive airway pressure in decompensated hypercapnic respiratory failure as a complication of sleep apnea. Chest 1993 104 770-774. Sturani C, Galavotti Y, Scarduelli C, et al. Acute respiratory failure due to severe obstructive sleep apnea syndrome, managed with nasal positive pressure ventilation. Monaldi Arch Chest Dis 1994 49 558-560. 

Nava S, Fanfulla F, Frigerio P, et al. Physiologic evaluation of 4 weeks of nocturnal nasal positive pressure ventilation in stable hypercapnic patients with chronic obstructive pulmonary disease. Respiration 2001 68(6) 573-583. 

Figure 1 Transition of the number of patients with HMV. Abbreviations HMV, home mechanical ventilation NPPV, nasal positive pressure ventilation TIPPV, tracheal invasive positive pressure ventilation.

Noninvasive positive-pressure ventilation (NPPV) provides ventilatory support with oxygen and pressurized airflow using a face or nasal mask with a tight seal but without endotracheal intubation. In patients with acute respiratory failure due to COPD exacerbations, NPPV was associated with lower mortality, lower intubation rates, shorter hospital stays, and greater improvements in serum pH in 1 hour compared with usual care. Use of NPPV reduces the complications that often arise with invasive mechanical ventilation. NPPV is not appropriate for patients with altered mental status, severe acidosis, respiratory arrest, or cardiovascular instability. 

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. 

When nasal sufentanil was used to induce anesthesia in children, ventilatory compliance was mildly or markedly reduced and one child required suxamethonium, oxygen, and positive pressure ventilation (SEDA-16, 86). 

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. 

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. 

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. 

Strumpf DA, Millman RP, Carhsle CC, et al. Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1991 144 1234-1239. 

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. 

Ellis ER, Bye FTP, Bruderer JW, et al. Treatment of respiratory failure during sleep in patients with neuromuscular disease. Positive-pressure ventilation through a nasal mask. Am Rev Respir Dis 1987 135 148-152. 

Cazzolli PA, Oppenheimer EA. Use of nasal and tracheostomy positive pressure ventilation in patients with amyotrophic lateral sclerosis (ALS). Abstracts of Papers, 7th International Conference on Noninvasive Ventilation Across the Spectrum from Critical Care to Home Care, Orlando, Florida, March 14-17, 1999. 

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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