Chest
Volume 99, Issue 3, March 1991, Pages 681-684
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Intermittent Volume Cycled Mechanical Ventilation Via Nasal Mask in Patients With Respiratory Failure Due to COPD*

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Intermittent mechanical ventilation via nasal CPAP mask was provided to 13 patients admitted to this institution for exacerbation of chronic respiratory failure. Ten suffered from COPD, two suffered from obesity hypoventilation syndrome (OHS), and one from severe hypothyroidism. All except one presented with dyspnea and hypercapnia due solely to progression of their underlying disease processes. Six of the patients with COPD and the patient with hypothyroidism responded to positive pressure ventilation by mask with improvements in blood gas values and clinical status. The remaining two patients with COPD and the two patients with OHS were unable to use the system. Four of the patients with COPD and chronic respiratory failure have been subsequently maintained on daily volume ventilation via nasal mask for about 20 months with persistent clinical and physiologic improvements. Application of volume ventilation through the nasal CPAP mask is a feasible strategy for providing long-term mechanical ventilation to selected patients with COPD and respiratory failure. (Chest 1991; 99:681–84)

Section snippets

Patient Selection

Thirteen patients admitted to Our Lady of Mercy Medical Center with respiratory failure were provided with volume cycled positive pressure ventilation via CPAP mask. Ten had COPD, two had obesity hypoventilation syndrome, and one had severe hypothyroidism. The mean age was 71 years (40 to 80). There were six men and seven women. One of the patients with COPD was the only one with an acute illness (pneumonia). All others had well-documented progressive respiratory failure for periods ranging

Acute Utility

Of the 13 patients, nine showed substantial acute improvement over one to three days on a continuous regimen of 2- to 3-h periods of mechanical ventilation separated by 1 h of rest. This was shown by statistically significant decreases in respiratory rate, PCO2, and heart rate (Table 1). The four remaining patients (two with COPD and two with obesity hypoventilation syndrome) failed to improve their ventilation, blood gas levels, or clinical status. One of the patients with COPD had a severely

DISCUSSION

Long-term mechanical ventilation, applied either intermittently or continuously, has been shown to benefit numerous patients with chronic respiratory failure due to various disease processes.1,2,4,6 The majority of patients so treated without tracheostomy have previously been ventilated with cuirass or tank respirator.1,2,4 Positive pressure ventilation has been administered via the lipseal device, but this is rather uncomfortable.9 The advent of the availability of tight sealing full face CPAP

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