Low-intensity noninvasive ventilation: Lower pressure, more exacerbations of chronic respiratory failure

• Main Authors: Toru Kadowaki, Kiryo Wakabayashi, Masahiro Kimura, Kanako Kobayashi, Toshikazu Ikeda, Shuichi Yano
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2016-01-01
• Series: Annals of Thoracic Medicine
• Subjects: Adjustment; chronic respiratory failure; exacerbation; low-intensity noninvasive positive pressure ventilation; noninvasive positive pressure ventilation
• Online Access: http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2016;volume=11;issue=2;spage=141;epage=145;aulast=Kadowaki
• ISSN: 1817-1737; 1998-3557

Background: For patients with chronic respiratory failure (CRF) who are treated with noninvasive positive pressure ventilation (NPPV), a little is known regarding the effects of low-intensity NPPV (LI-NPPV) on the clinical course of CRF and the frequency of adjustments in these patients. Objectives: This study investigated the effects of LI-NPPV on the clinical course of patients with CRF as compared with patients who were treated with conventional NPPV (C-NPPV) and determined how frequently NPPV was adjusted during therapy. Methods: Clinical data from 21 patients who received long-term NPPV were retrospectively analyzed. Patients were categorized into two groups based on the level of initial pressure support (PS): C-NPPV group (PS ≥ 10 cm H2O) and LI-NPPV group (PS < 10 cm H2O). Results: Patients in the LI-NPPV group had significantly more exacerbations of CRF (P < 0.05). There was no significant difference in the number of patients who required adjustments of NPPV settings between the two groups. There was no significant difference in PaCO2levels 1 month after the start of NPPV between the two groups; however, PaCO2levels were significantly lower after 1 year in the C-group (P < 0.001). Seventy-one percent of LI-NPPV patients and 43% of C-NPPV patients needed NPPV adjustments. Conclusions: Attention should be paid to CRF patients who are initially administered LI-NPPV; they should be carefully observed because they can develop more exacerbations of CRF than patients undergoing C-NPPV. If possible, higher initial PS should be administered to prevent CRF exacerbations.