Rationale for NIPPV in Patients with COPD

Restoration of central chemosensitivity— by the effective control of nocturnal hypoventilation— has been shown in patients with severe obstructive sleep apnea (13), neuromuscular disease (14), and chest wall deformity as well as patients with COPD (15,16). 

Reducing the Load Against Which the Respiratory Muscie Pump Has to Function 

In conclusion, although several theories exist, there are currently no studies on negative predictive value (NPV) or NIPPV that have provided definitive evidence that the benefits in gas exchange were related to improvements in respiratory muscle function or in sleep efficiency. The relationship between improved gas exchange and hyperinflation needs further investigation. The restoration of the central drive to breathe is the most consistent finding. It is therefore important in any evaluation of NIPPV to be confident that nocturnal hypoventilation has been reduced. 

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