Using nasal intermittent positive pressure ventilation on a general respiratory ward.

OBJECTIVES

To assess the use of nasal intermittent positive pressure ventilation (NIPPV) in treating acute-on-chronic respiratory failure in a general medical ward.

DESIGN

Retrospective analysis of clinical outcome.

SETTING

A general medical ward of a tertiary respiratory medicine referral centre.

SUBJECTS

Altogether 75 patients admitted with acute exacerbations of chronic respiratory failure and treated NIPPV.

MAIN OUTCOME MEASURES

Blood gas tensions determined at admission to hospital and during NIPPV, tolerance of NIPPV and mortality.

RESULTS

During treatment with NIPPV, the mean (SD) PaO2 increased rapidly by 2.31 (3.58) kPa (p < 0.0001), while the mean PaCO2 fell by 1.07 (1.74) kPa (p < 0.0001) and the mean pH increased by 0.03 (0.07) (p = 0.001). Altogether 57 (76%) of patients tolerated NIPPV, and (9.3%) died in hospital. Improvement in PaO2 was more noticeable in patients with chronic obstructive pulmonary disease (+3.13 (3.49) kPa, p < 0.0001) than in those with restrictive chest wall disease (+1.20 (3.07) kPa, p = 0.25) or obstructive sleep apnoea (+0.18 (3.64), p = 0.88). The reduction in PaCO2 was similar in all three groups.

CONCLUSIONS

In routine treatment of unselected patients with acute-on-chronic respiratory failure who are being cared for on a general ward, NIPPV rapidly improves hypoxaemia and hypercapnia, is well tolerated and is associated with low mortality.