Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask

Article Abstract:

Acute episodes of chronic obstructive pulmonary disease (COPD) often require endotracheal intubation (a tube inserted into the trachea, or windpipe, through an incision in the neck) and mechanical ventilation, or both. Among the complications arising from this procedure are hospital-acquired pneumonia, injury from the increased air pressure, and injury to the trachea. Previous attempts at noninvasive methods of ventilatory assistance are difficult for routine use and require cooperation from the patient. They are not sensitive to the patient's breathing, do not maintain even pressure, resist the patient's expiratory pressure, and are expensive. The new method described in this article, known as inspiratory pressure support, does not require intubation and was designed to be inexpensive. It provides partial ventilatory assistance through a face mask, applying constant positive pressure during the patient's spontaneous inspiration. This method improves blood gas exchange and, in intubated patients, reduces the work of the respiratory muscles during weaning from mechanical ventilation. To determine short-term physiologic effects, this method was tested on 11 patients with COPD, and 13 patients (6 from the previous group) with COPD and acute respiratory distress. These patients were matched with 13 patients whose COPD was treated conventionally. The results suggest that an external inspiratory-assistance device can improve blood gas exchange efficiency and decrease the work of the respiratory muscles. In most patients, endotracheal intubation was avoided, leading to shorter stays in the intensive care unit. During acute respiratory distress, a mouthpiece is necessary when patients breathe through their mouths; this requires the patient's cooperation and limits the usefulness of the device. The inspiratory-assistance face mask was well tolerated and there were no side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Respiratory therapy, Positive pressure respiration

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Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease

Article Abstract:

Artificial respiration with a face mask rather than with nasal prongs may reduce the need for intubation, the risk of complications and death, and the length of hospital stay in patients with lung disease. Intubation is the insertion of a tube down the windpipe for direct delivery of air to the lungs. Of 85 patients with chronic obstructive lung disease, 42 received artificial respiration through nasal prongs and 43 received respiration through a special face mask that delivered pressurized air. Intubation was needed by 74% of the nasal prong group, but only 26% of the face mask group. Complications such as pneumonia and infection occurred in 48% of the nasal prong group, but only 16% of the face mask group. The percentage of patients who died in the hospital was 29% in the nasal prong group and 9% in the face mask group. The higher rate of complications and death in the nasal prong group was probably caused by a higher rate of intubation.

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Noninvasive ventilation in chronic obstructive pulmonary disease

Article Abstract:

Patients with chronic obstructive lung disease should receive artificial respiration through a noninvasive face mask early during an episode of labored breathing. A 1995 study found that respiration with a pressurized face mask reduced the need for intubation, the incidence of complications, the death rate, and the duration of hospital stay in patients with obstructive lung disease. Intubation is the insertion of a breathing tube. Other studies have shown that improvement of these patients depends on rapid correction of increased acid and carbon dioxide levels in the blood. Once the blood becomes slightly acidic and carbon dioxide levels rise intubation may be needed. Intubation increases the risk of severe complications and death. Early administration of pressurized face-mask respiration may help prevent the need for intubation, thus allowing for improved prognosis and cost reduction.

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