Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1995 Jun;50(6):604–609. doi: 10.1136/thx.50.6.604

Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders.

A K Simonds 1, M W Elliott 1
PMCID: PMC1021256  PMID: 7638799

Abstract

BACKGROUND--Nasal intermittent positive pressure ventilation (NIPPV) is a new technique which has rapidly supplanted other non-invasive methods of ventilation over the last 5-10 years. Data on its effectiveness are limited. METHODS--The outcome of long term domiciliary NIPPV has been analysed in 180 patients with hypercapnic respiratory failure predominantly due to chest wall restriction, neuromuscular disorders, or chronic obstructive lung disease. One hundred and thirty eight patients were started on NIPPV electively, and 42 following an acute hypercapnic exacerbation. Outcome measures were survival (five year probability of continuing NIPPV), pulmonary function, and health status. A crossover study from negative pressure ventilation to NIPPV was carried out in a subgroup of patients. RESULTS--Five year acturial probability of continuing NIPPV for individuals with early onset scoliosis (n = 47), previous poliomyelitis (n = 30), following tuberculous lung disease (n = 20), general neuromuscular disorders (n = 29), and chronic obstructive pulmonary disease (n = 33) was 79% (95% CI 66 to 92), 100%, 94% (95% CI 83 to 100), 81% (95% CI 61 to 100), 43% (95% CI 6 to 80), respectively. Most of the patients with bronchiectasis died within two years. One year after starting NIPPV electively the mean (SD) PaO2 compared with the pretreatment value was +1.8 (1.9) kPa, mean PaCO2 -1.4 (1.3) kPa in patients with extrapulmonary restrictive disorders, and PaO2 +0.8 (1.0) kPa, PaCO2 -0.9 (0.8) kPa in patients with obstructive lung disease. Arterial blood gas tensions improved in patients transferred from negative pressure ventilation to NIPPV. Health status was ranked highest in patients with early onset scoliosis, previous poliomyelitis, and following tuberculous lung disease. In the group as a whole health perception was comparable to outpatients with other chronic disorders. CONCLUSIONS--The long term outcome of domiciliary NIPPV in patients with chronic respiratory failure due to scoliosis, previous poliomyelitis, and chest wall and pulmonary disease secondary to tuberculosis is encouraging. The results of NIPPV in patients with COPD and progressive neuromuscular disorders show benefit in some subgroups. The outcome in end stage bronchiectasis is poor.

Full text

PDF
604

Images in this article

607Image
on p.607

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bott J., Carroll M. P., Conway J. H., Keilty S. E., Ward E. M., Brown A. M., Paul E. A., Elliott M. W., Godfrey R. C., Wedzicha J. A. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet. 1993 Jun 19;341(8860):1555–1557. doi: 10.1016/0140-6736(93)90696-e. [DOI] [PubMed] [Google Scholar]
  2. Brazier J. E., Harper R., Jones N. M., O'Cathain A., Thomas K. J., Usherwood T., Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160–164. doi: 10.1136/bmj.305.6846.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brochard L., Isabey D., Piquet J., Amaro P., Mancebo J., Messadi A. A., Brun-Buisson C., Rauss A., Lemaire F., Harf A. Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med. 1990 Nov 29;323(22):1523–1530. doi: 10.1056/NEJM199011293232204. [DOI] [PubMed] [Google Scholar]
  4. Cooper C. B., Waterhouse J., Howard P. Twelve year clinical study of patients with hypoxic cor pulmonale given long term domiciliary oxygen therapy. Thorax. 1987 Feb;42(2):105–110. doi: 10.1136/thx.42.2.105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Elliott M. W., Mulvey D. A., Moxham J., Green M., Branthwaite M. A. Domiciliary nocturnal nasal intermittent positive pressure ventilation in COPD: mechanisms underlying changes in arterial blood gas tensions. Eur Respir J. 1991 Oct;4(9):1044–1052. [PubMed] [Google Scholar]
  6. Elliott M. W., Simonds A. K., Carroll M. P., Wedzicha J. A., Branthwaite M. A. 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 May;47(5):342–348. doi: 10.1136/thx.47.5.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Elliott M. W., Steven M. H., Phillips G. D., Branthwaite M. A. Non-invasive mechanical ventilation for acute respiratory failure. BMJ. 1990 Feb 10;300(6721):358–360. doi: 10.1136/bmj.300.6721.358. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Freyschuss U., Nilsonne U., Lundgren K. D. Idiopathic scoliosis in old age. I. Respiratory function. Acta Med Scand. 1968 Nov;184(5):365–372. doi: 10.1111/j.0954-6820.1968.tb02472.x. [DOI] [PubMed] [Google Scholar]
  9. Hill N. S., Eveloff S. E., Carlisle C. C., Goff S. G. Efficacy of nocturnal nasal ventilation in patients with restrictive thoracic disease. Am Rev Respir Dis. 1992 Feb;145(2 Pt 1):365–371. doi: 10.1164/ajrccm/145.2_Pt_1.365. [DOI] [PubMed] [Google Scholar]
  10. Hill N. S. Noninvasive ventilation. Does it work, for whom, and how? Am Rev Respir Dis. 1993 Apr;147(4):1050–1055. doi: 10.1164/ajrccm/147.4.1050. [DOI] [PubMed] [Google Scholar]
  11. Hodson M. E., Madden B. P., Steven M. H., Tsang V. T., Yacoub M. H. Non-invasive mechanical ventilation for cystic fibrosis patients--a potential bridge to transplantation. Eur Respir J. 1991 May;4(5):524–527. [PubMed] [Google Scholar]
  12. Leger P., Bedicam J. M., Cornette A., Reybet-Degat O., Langevin B., Polu J. M., Jeannin L., Robert D. Nasal intermittent positive pressure ventilation. Long-term follow-up in patients with severe chronic respiratory insufficiency. Chest. 1994 Jan;105(1):100–105. doi: 10.1378/chest.105.1.100. [DOI] [PubMed] [Google Scholar]
  13. Levy R. D., Bradley T. D., Newman S. L., Macklem P. T., Martin J. G. Negative pressure ventilation. Effects on ventilation during sleep in normal subjects. Chest. 1989 Jan;95(1):95–99. doi: 10.1378/chest.95.1.95. [DOI] [PubMed] [Google Scholar]
  14. McHorney C. A., Ware J. E., Jr, Raczek A. E. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993 Mar;31(3):247–263. doi: 10.1097/00005650-199303000-00006. [DOI] [PubMed] [Google Scholar]
  15. Meduri G. U., Conoscenti C. C., Menashe P., Nair S. Noninvasive face mask ventilation in patients with acute respiratory failure. Chest. 1989 Apr;95(4):865–870. doi: 10.1378/chest.95.4.865. [DOI] [PubMed] [Google Scholar]
  16. Muir J. F. Pulmonary rehabilitation in chronic respiratory insufficiency. 5. Home mechanical ventilation. Thorax. 1993 Dec;48(12):1264–1273. doi: 10.1136/thx.48.12.1264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Pehrsson K., Olofson J., Larsson S., Sullivan M. Quality of life of patients treated by home mechanical ventilation due to restrictive ventilatory disorders. Respir Med. 1994 Jan;88(1):21–26. doi: 10.1016/0954-6111(94)90169-4. [DOI] [PubMed] [Google Scholar]
  18. Sawicka E. H., Loh L., Branthwaite M. A. Domiciliary ventilatory support: an analysis of outcome. Thorax. 1988 Jan;43(1):31–35. doi: 10.1136/thx.43.1.31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Shapiro S. H., Ernst P., Gray-Donald K., Martin J. G., Wood-Dauphinee S., Beaupré A., Spitzer W. O., Macklem P. T. Effect of negative pressure ventilation in severe chronic obstructive pulmonary disease. Lancet. 1992 Dec 12;340(8833):1425–1429. doi: 10.1016/0140-6736(92)92620-u. [DOI] [PubMed] [Google Scholar]
  20. Shapiro S. H., Ernst P., Gray-Donald K., Martin J. G., Wood-Dauphinee S., Beaupré A., Spitzer W. O., Macklem P. T. Effect of negative pressure ventilation in severe chronic obstructive pulmonary disease. Lancet. 1992 Dec 12;340(8833):1425–1429. doi: 10.1016/0140-6736(92)92620-u. [DOI] [PubMed] [Google Scholar]
  21. Strumpf D. A., Millman R. P., Carlisle C. C., Grattan L. M., Ryan S. M., Erickson A. D., Hill N. S. Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis. 1991 Dec;144(6):1234–1239. doi: 10.1164/ajrccm/144.6.1234. [DOI] [PubMed] [Google Scholar]
  22. Udwadia Z. F., Santis G. K., Steven M. H., Simonds A. K. Nasal ventilation to facilitate weaning in patients with chronic respiratory insufficiency. Thorax. 1992 Sep;47(9):715–718. doi: 10.1136/thx.47.9.715. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES