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 disorder in COPD are discussed separately. (See "Noninvasive ventilation in acute respiratory failure in adults" and "Sleep-related breathing disorders in COPD".)
RATIONALE FOR RESPIRATORY MUSCLE REST
It has been hypothesized that nocturnal noninvasive ventilation can improve both nocturnal and daytime respiratory function in patients with advanced COPD by providing periods of rest for weakened respiratory muscles. The evidence related to this hypothesis is of limited quality and conflicting, as described below [1-7].
Respiratory muscle weakness in chronic obstructive pulmonary disease (COPD) probably results from a number of factors including the following :
●Change in configuration of the diaphragm caused by hyperinflation
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- RATIONALE FOR RESPIRATORY MUSCLE REST
- NEGATIVE PRESSURE VENTILATION
- EVIDENCE FOR NOCTURNAL NPPV
- Dyspnea, hypersomnolence, pulmonary function, and PaCO2
- Effects on hospitalization and mortality
- Rehabilitation and NPPV
- PATIENT SELECTION
- PRACTICAL ASPECTS
- FUTURE DIRECTIONS
- SUMMARY AND RECOMMENDATIONS