Nocturnal ventilatory support in COPD
- Peter C Gay, MD
Peter C Gay, MD
- Professor Of Medicine
- Mayo Medical School
Nocturnal alterations in gas exchange, such as oxygen desaturation and hypercapnia, are an important clinical problem in patients with chronic obstructive pulmonary disease (COPD). Potential forms of treatment include supplemental oxygen, pharmacologic agents, and nocturnal ventilatory support. (See "Sleep-related breathing disorders in COPD".)
The use of nocturnal ventilatory support in the management of patients with stable COPD will be reviewed here. The management of acute exacerbations of COPD and sleep-related breathing disorders in COPD are discussed separately. (See "Noninvasive ventilation in acute respiratory failure in adults" and "Sleep-related breathing disorders in COPD".)
RESPIRATORY MUSCLE WEAKNESS IN COPD
In severe COPD, hypercapnia is largely due to poor matching of ventilation and perfusion, known as V/Q mismatch or dead space ventilation, which is a result of lung parenchyma and airway destruction. Some patients are able to partially compensate by increasing their minute ventilation, but others are not, possibly related to respiratory muscle weakness and other issues listed below.
Respiratory muscle weakness in patients with COPD probably results from a number of factors including the following :
●Change in configuration of the diaphragm caused by hyperinflation, which puts the diaphragm at a mechanical disadvantage
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- RESPIRATORY MUSCLE WEAKNESS IN COPD
- Rationale for respiratory muscle rest
- PATIENT SELECTION FOR NOCTURNAL NIV
- NIV initiated during exacerbation
- Outpatients with chronic respiratory failure
- PRACTICAL ASPECTS
- Location of NIV initiation
- PAP selection
- Protocol for initiation in stable patients
- Treatment failure
- EFFICACY OF NOCTURNAL NIV
- Effects on hospitalization and mortality
- Dyspnea, hypersomnolence, pulmonary function, and PaCO2
- Rehabilitation and nocturnal NIV
- NEGATIVE PRESSURE VENTILATION
- FUTURE DIRECTIONS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS