High Intensity Non-Invasive Positive Pressure Ventilation (HINPPV) for Stable Hypercapnic Chronic Obstructive Pulmonary Disease (COPD) Patients.

High intensity non-invasive positive pressure ventilation (HI-NPPV) is an algorithm of non-invasive ventilation that has been shown to improve partial pressure of carbon dioxide (PaCO), health-related quality of life and mortality in hypercapnic chronic obstructive pulmonary disease (COPD) patients. Assess 3 months of HI-NPPV in stable hypercapnic COPD patients. A single arm, non-randomized pilot study of HI-NPPV. Patients were eligible if they had clinically stable COPD and daytime arterial PaCO >50 mmHg. Nine patients completed therapy. Patient characteristics: 2 male: 7 female, mean age of 64.4 years (SD ±6.6), mean forced expiratory volume in 1 second (FEV) of 26% (SD±6.73), 8 patients on long term oxygen therapy (LTOT) and a median body mass index (BMI) of 26.6 (interquartile range [IQR] 25.5 - 32.5). There was a mean reduction in daytime PaCO by 4.66 mmHg (=0.01) and bicarbonate by 2.16 mmHg (=0.005). There was no statistically significant difference in lung function, maximal inspiratory pressures or 6 minute walk distance. There was no statistically significant difference in sleep duration, efficiency or percentage of sleep stage 3 ( N3) or rapid eye movement (REM). The Chronic Respiratory Questionnaire (CRQ) showed a trend towards improvement with an increase of 2.69 points (=0.054), the dyspnea domain showed a statistically significant improvement (=0.03). The Calgary Sleep Apnea Quality of Life Index (SAQLI) detected an improvement in daily functioning (=0.007). The Severe Respiratory Insufficiency (SRI) Questionnaire showed a trend to improvement overall (=0.05). Four patients had COPD exacerbations during the follow up period. HI-NPPV is able to substantially reduce PaCO in hypercapnic COPD patients; we detected a positive effect on quality of life measures with no significant change in sleep quality.