FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 323:1523-1530 November 29, 1990 Number 22 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

BACKGROUND. Patients with acute exacerbations of chronic obstructive pulmonary disease may require endotracheal intubation with mechanical ventilation. We designed, and here report on the efficacy of, a noninvasive ventilatory-assistance apparatus to provide inspiratory-pressure support by means of a face mask. METHODS. We assessed the short-term (45-minute) physiologic effects of the apparatus in 11 patients with acute exacerbations of chronic obstructive pulmonary disease and evaluated its therapeutic efficacy in 13 such patients (including 3 of the 11 in the physiologic study) who were treated for several days and compared with 13 matched historical-control patients. RESULTS. In the physiologic study, after 45 minutes of inspiratory positive airway pressure by face mask, the mean (+/- SD) arterial pH rose from 7.31 +/- 0.08 to 7.38 +/- 0.07 (P less than 0.01), the partial pressure of carbon dioxide fell from 68 +/- 17 mm Hg to 55 +/- 15 mm Hg (P less than 0.01), and the partial pressure of oxygen rose from 52 +/- 12 mm Hg to 69 +/- 16 mm Hg (P less than 0.05). These changes were accompanied by marked reductions in respiratory rate (from 31 +/- 7 to 21 +/- 9 breaths per minute, P less than 0.01). Only 1 of the 13 patients treated with inspiratory positive airway pressure needed tracheal intubation and mechanical ventilation, as compared with 11 of the 13 historical controls (P less than 0.001). Two patients in each group died. As compared with the controls, the treated patients had a more transient need for ventilatory assistance (3 +/- 1 vs. 12 +/- 11 days, P less than 0.01) and a shorter stay in the intensive care unit (7 +/- 3 vs. 19 +/- 13 days, P less than 0.01). CONCLUSIONS. Inspiratory positive airway pressure delivered by a face mask can obviate the need for conventional mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease.

Source Information

Department of Physiology, University of Paris XII, Henri Mondor Hospital, Creteil, France.

This article has been cited by other articles:

• Tobin, M. J., Laghi, F., Brochard, L. (2009). Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J. Appl. Physiol. 107: 962-970 [Abstract] [Full Text]  
• Celebi, S., Koner, O., Menda, F., Omay, O., Gunay, I., Suzer, K., Cakar, N. (2008). Pulmonary Effects of Noninvasive Ventilation Combined with the Recruitment Maneuver After Cardiac Surgery. Anesth. Analg. 107: 614-619 [Abstract] [Full Text]  
• GERSHMAN, A. J., REDDY, A. J., BUDEV, M. M., MAZZONE, P. J. (2008). Q: Does noninvasive positive pressure ventilation have a role in managing hypercapnic respiratory failure due to an acute exacerbation of COPD?. Cleveland Clinic Journal of Medicine 75: 458-461 [Full Text]  
• Marik, P. E. (2007). Noninvasive Positive-Pressure Ventilation in Patients With Malignancy. AM J HOSP PALLIAT CARE 24: 417-421 [Abstract]  
• Garpestad, E., Brennan, J., Hill, N. S. (2007). Noninvasive Ventilation for Critical Care. Chest 132: 711-720 [Abstract] [Full Text]  
• El Solh, A. A., Ramadan, F. H. (2006). Overview of Respiratory Failure in Older Adults. J Intensive Care Med 21: 345-351 [Abstract]  
• Chakrabarti, B, Calverley, P M A (2006). Management of acute ventilatory failure.. Postgrad. Med. J. 82: 438-445 [Abstract] [Full Text]  
• Rodriguez-Roisin, R (2006). COPD exacerbations {middle dot} 5: Management.. Thorax 61: 535-544 [Abstract] [Full Text]  
• O'Donnell, D E, Parker, C M (2006). COPD exacerbations {middle dot} 3: Pathophysiology.. Thorax 61: 354-361 [Abstract] [Full Text]  
• Jaber, S., Delay, J.-M., Chanques, G., Sebbane, M., Jacquet, E., Souche, B., Perrigault, P.-F., Eledjam, J.-J. (2005). Outcomes of Patients With Acute Respiratory Failure After Abdominal Surgery Treated With Noninvasive Positive Pressure Ventilation. Chest 128: 2688-2695 [Abstract] [Full Text]  
• Ranieri, V. M., Squadrone, V. (2005). Continuous Positive Airway Pressure and Postoperative Hypoxemia--Reply. JAMA 293: 2714-2715 [Full Text]  
• Stevens, K. (2005). Review: adding non-invasive positive pressure ventilation to usual care reduces treatment failure in respiratory failure. Evid. Based Nurs. 8: 22-22 [Full Text]  
• Girou, E., Brun-Buisson, C., Taille, S., Lemaire, F., Brochard, L. (2003). Secular Trends in Nosocomial Infections and Mortality Associated With Noninvasive Ventilation in Patients With Exacerbation of COPD and Pulmonary Edema. JAMA 290: 2985-2991 [Abstract] [Full Text]  
• Brochard, L. (2003). Mechanical ventilation: invasive versus noninvasive. Eur Respir J 22: 31s-37s [Abstract] [Full Text]  
• Sharshar, T., Desmarais, G., Louis, B., Macadou, G., Porcher, R., Harf, A., Raphael, J.-C., Isabey, D., Lofaso, F. (2003). Transdiaphragmatic Pressure Control of Airway Pressure Support in Healthy Subjects. Am. J. Respir. Crit. Care Med. 168: 760-769 [Abstract] [Full Text]  
• Liesching, T., Kwok, H., Hill, N. S. (2003). Acute Applications of Noninvasive Positive Pressure Ventilation. Chest 124: 699-713 [Abstract] [Full Text]  
• Keenan, S. P., Sinuff, T., Cook, D. J., Hill, N. S. (2003). Which Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Benefit from Noninvasive Positive-Pressure Ventilation? A Systematic Review of the Literature. ANN INTERN MED 138: 861-870 [Abstract] [Full Text]  
• Lightowler, J. V, Wedzicha, J. A, Elliott, M. W, Ram, F. S F (2003). Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 326: 185-185 [Abstract] [Full Text]  
• Norregaard, O. (2002). Noninvasive ventilation in children. Eur Respir J 20: 1332-1342 [Abstract] [Full Text]  
• Thys, F., Roeseler, J., Reynaert, M., Liistro, G., Rodenstein, D.O. (2002). Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial. Eur Respir J 20: 545-555 [Abstract] [Full Text]  
• Afifi, S. (2002). Lung Protective Ventilation Strategies. SEMIN CARDIOTHORAC VASC ANESTH 6: 259-269 [Abstract]  
• Brochard, L. (2002). Noninvasive Ventilation for Acute Respiratory Failure. JAMA 288: 932-935 [Full Text]  
• (2002). ATS/ERS Statement on Respiratory Muscle Testing. Am. J. Respir. Crit. Care Med. 166: 518-624 [Full Text]  
• Vanpee, D., El Khawand, C., Rousseau, L., Jamart, J., Delaunois, L. (2002). Effects of Nasal Pressure Support on Ventilation and Inspiratory Work in Normocapnic and Hypercapnic Patients With Stable COPD*. Chest 122: 75-83 [Abstract] [Full Text]  
• Brochard, L., Mancebo, J., Elliott, M.W. (2002). Noninvasive ventilation for acute respiratory failure. Eur Respir J 19: 712-721 [Abstract] [Full Text]  
• (2002). Non-invasive ventilation in acute respiratory failure. Thorax 57: 192-211 [Full Text]  
• AURIANT, I., JALLOT, A., HERVE, P., CERRINA, J., LE ROY LADURIE, F., FOURNIER, J. L., LESCOT, B., PARQUIN, F. (2001). Noninvasive Ventilation Reduces Mortality in Acute Respiratory Failure following Lung Resection. Am. J. Respir. Crit. Care Med. 164: 1231-1235 [Abstract] [Full Text]  
• Wysocki, M., Antonelli, M. (2001). Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure. Eur Respir J 18: 209-220 [Abstract] [Full Text]  
• Willson, G.N., Wilcox, I., Piper, A.J., Flynn, W.E., Norman, M., Grunstein, R.R., Sullivan, C.E. (2001). Noninvasive pressure preset ventilation for the treatment of Cheyne-Stokes respiration during sleep. Eur Respir J 17: 1250-1257 [Abstract] [Full Text]  
• Cuvelier, A., Muir, J-F. (2001). Noninvasive ventilation and obstructive lung diseases. Eur Respir J 17: 1271-1281 [Abstract] [Full Text]  
• GORINI, M., CORRADO, A., VILLELLA, G., GINANNI, R., AUGUSTYNEN, A., TOZZI, D. (2001). Physiologic Effects of Negative Pressure Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 163: 1614-1618 [Abstract] [Full Text]  
• Bach, P. B., Brown, C., Gelfand, S. E., McCrory, D. C. (2001). Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Summary and Appraisal of Published Evidence. ANN INTERN MED 134: 600-620 [Abstract] [Full Text]  
• McCrory, D. C., Brown, C., Gelfand, S. E., Bach, P. B. (2001). Management of Acute Exacerbations of COPD : A Summary and Appraisal of Published Evidence. Chest 119: 1190-1209 [Abstract] [Full Text]  
• CARLUCCI, A., RICHARD, J.-C., WYSOCKI, M., LEPAGE, E., BROCHARD, L., the SRLF Collaborative Group o, (2001). Noninvasive Versus Conventional Mechanical Ventilation . An Epidemiologic Survey. Am. J. Respir. Crit. Care Med. 163: 874-880 [Abstract] [Full Text]  
• Girou, E., Schortgen, F., Delclaux, C., Brun-Buisson, C., Blot, F., Lefort, Y., Lemaire, F., Brochard, L. (2000). Association of Noninvasive Ventilation With Nosocomial Infections and Survival in Critically Ill Patients. JAMA 284: 2361-2367 [Abstract] [Full Text]  
• Younes, M. (2000). Dynamic Intrinsic PEEP (PEEPi,dyn) . Is It Worth Saving?. Am. J. Respir. Crit. Care Med. 162: 1608-1609 [Full Text]  
• Sinuff, T., Cook, D., Randall, J., Allen, C. (2000). Noninvasive positive-pressure ventilation: a utilization review of use in a teaching hospital. CMAJ 163: 969-973 [Abstract] [Full Text]  
• BROCHARD, L. (2000). Non-invasive ventilation for acute exacerbations of COPD: a new standard of care. Thorax 55: 817-818 [Full Text]  
• JABER, S., FODIL, R., CARLUCCI, A., BOUSSARSAR, M., PIGEOT, J., LEMAIRE, F., HARF, A., LOFASO, F., ISABEY, D., BROCHARD, L. (2000). Noninvasive Ventilation with Helium-Oxygen in Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 161: 1191-1200 [Abstract] [Full Text]  
• Anton, A., Guell, R., Gomez, J., Serrano, J., Castellano, A., Carrasco, J. L., Sanchis, J. (2000). Predicting the Result of Noninvasive Ventilation in Severe Acute Exacerbations of Patients With Chronic Airflow Limitation. Chest 117: 828-833 [Abstract] [Full Text]  
• Cross, A. M (2000). Review of the role of non-invasive ventilation in the emergency department. Emerg. Med. J. 17: 79-85 [Full Text]  
• Long, F. R., Castile, R. G., Brody, A. S., Hogan, M. J., Flucke, R. L., Filbrun, D. A., McCoy, K. S. (1999). Lungs in Infants and Young Children: Improved Thin-Section CT with a Noninvasive Controlled-Ventilation Technique—Initial Experience. Radiology 212: 588-593 [Abstract] [Full Text]  
• Fauroux, B., Boulé, M., Lofaso, F., Zérah, F., Clément, A., Harf, A., Isabey, D. (1999). Chest Physiotherapy in Cystic Fibrosis: Improved Tolerance With Nasal Pressure Support Ventilation. Pediatrics 103: 32e-32 [Abstract] [Full Text]  
• Rocker, G. M., Mackenzie, M.-G., Williams, B., Logan, P. M. (1999). Noninvasive Positive Pressure Ventilation: Successful Outcome in Patients With Acute Lung Injury/ARDS. Chest 115: 173-177 [Abstract] [Full Text]  
• Hillberg, R. E., Johnson, D. C. (1997). Noninvasive Ventilation. NEJM 337: 1746-1752 [Full Text]  
• Diaz, O, Iglesia, R, Ferrer, M, Zavala, E, Santos, C, Wagner, P., Roca, J, Rodriguez- Roisin, R (1997). Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 156: 1840-1845 [Abstract] [Full Text]  
• Seneff, M. G., Wagner, D. P., Wagner, R. P., Zimmerman, J. E., Knaus, W. A. (1995). Hospital and 1-Year Survival of Patients Admitted to Intensive Care Units With Acute Exacerbation of Chronic Obstructive Pulmonary Disease. JAMA 274: 1852-1857 [Abstract]  
• Brochard, L., Mancebo, J., Wysocki, M., Lofaso, F., Conti, G., Rauss, A., Simonneau, G., Benito, S., Gasparetto, A., Lemaire, F., Isabey, D., Harf, A. (1995). Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. NEJM 333: 817-822 [Abstract] [Full Text]  
• Elliott, M. W. (1995). Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease. NEJM 333: 870-871 [Full Text]  
• Tobin, M. J. (1994). Mechanical Ventilation. NEJM 330: 1056-1061 [Full Text]  
• Weinberger, S. E. (1993). Recent Advances in Pulmonary Medicine- Second of Two Parts. NEJM 328: 1462-1470 [Full Text]  
• Dantzker, D. R., Steinberg, H. (1992). Pulmonary Medicine. JAMA 268: 405-407 [Abstract]  
• (1990). INSPIRATORY-ASSISTANCE FACE MASK IS BENEFICIAL IN ACUTE COPD. JWatch General 1990: 4-4 [Full Text]