Chest
Volume 116, Issue 2, August 1999, Pages 521-534
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Consensus Conference
Clinical Indications for Noninvasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to Restrictive Lung Disease, COPD, and Nocturnal Hypoventilation—A Consensus Conference Report

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Overview

The use of nasal positive pressure ventilation (NPPV) has been increasing at a rate that is alarming to third-party payers and particularly to the Health Care Financing Administration (HCFA), which pays for services provided to Medicare beneficiaries. New prescriptions for NPPV have been most notable in patients with COPD and also in those patients with obstructive sleep apnea (OSA) who are deemed to be intolerant of continuous positive airway pressure (CPAP).

NPPV services for Medicare patients

Overview

A wide variety of restrictive thoracic diseases have been successfully treated with NPPV, including thoracic cage abnormalities (eg, chest wall deformities, kyphoscoliosis, spinal cord injury, and sequelae of polio), in addition to both rapidly and slowly progressive neuromuscular conditions (eg, amyotrophic lateral sclerosis [ALS] and a medley of myopathic/neuropathic disorders). Data from France presented by Dr. Leger indicated that from 1984 to 1996, their NPPV population grew in number from

Overview

Severe COPD is a major cause of morbidity and mortality worldwide. Few of the many available therapies have been shown to significantly improve long-term patient outcomes. Long-term oxygen therapy is the only treatment demonstrated to prolong survival in controlled trials.1819 Bronchodilator and anti-inflammatory medications are used mainly for symptomatic relief; studies on long-term outcomes have shown minor or no benefit.20Controlled trials have demonstrated that pulmonary rehabilitation

Overview

Normally the respiratory system responds to changes in oxygen uptake and carbon dioxide production to maintain normal homeostasis. Homeostasis is accomplished by changes in minute ventilation, which maintains Po2 and Pco2within a normal physiologic range. Alveolar hypoventilation, which can be defined as an elevation in Pco2 > 45 mm Hg, can occur in a number of disorders that can be referred to as the “hypoventilation syndromes.” Associated with alveolar hypoventilation is the development of

Additional Recommendations for All Forms of NPPV

Consensus conference participants also agreed on matters related to additional research as well as the actual “Certificate of Medical Necessity” that would be required for Medicare payment.

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  • Cited by (0)

    From the conference facilitator was Allen Goldberg, MD, FCCP. Formal presenters included Patrick Leger, MD; Nicholas Hill, MD, FCCP; and Gerard Criner, MD, FCCP.

    Participants and the organizations they represented included Edward Oppenheimer, MD, FCCP, the American Academy of Home Care Physicians; Vijay Deshpande, RRT, The American Association for Respiratory Care; Walter J. O’Donohue, Jr., MD, FCCP, the American College of Chest Physicians; Jonathon Truwit, MD, The American College of Physicians; Mark Sanders, MD, FCCP, The American Sleep Disorders Association; Barry Make, MD, FCCP, The American Thoracic Society; Peter Gay, MD, FCCP, the Mayo Clinic; and Neil Mac Intyre, MD, FCCP, and Frederick Oldenburg, Jr., MD, FCCP, the National Association for Medical Direction of Respiratory Care. The American Academy of Family Physicians declinedthe invitation to participate in the conference.

    The conference was underwritten by an educational grant to NAMDRC fromthe Health Industry Manufacturers Association.

    Correspondence to: Phillip Porte, National Association for Medical Direction of Respiratory Care, 5454 Wisconsin Avenue, Suite 1270,Chevy Chase, MD 20815-6901[email protected]

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