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
- Rochester DF, Braun NM, Arora NS. Respiratory muscle strength in chronic obstructive pulmonary disease. Am Rev Respir Dis 1979; 119:151.
- Rochester DF, Braun NM, Laine S. Diaphragmatic energy expenditure in chronic respiratory failure. The effect of assisted ventilation with body respirators. Am J Med 1977; 63:223.
- Schönhofer B, Polkey MI, Suchi S, Köhler D. Effect of home mechanical ventilation on inspiratory muscle strength in COPD. Chest 2006; 130:1834.
- Garay SM, Turino GM, Goldring RM. Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Long-term maintenance with noninvasive nocturnal mechanical ventilation. Am J Med 1981; 70:269.
- Braun, NMT, Marino, WD. Effect of Daily Intermittent Rest of Respiratory Muscles in Patients with Severe Chronic Airflow Limitation (CAL). Chest 1984; 85:59S.
- Budweiser S, Heinemann F, Fischer W, et al. Long-term reduction of hyperinflation in stable COPD by non-invasive nocturnal home ventilation. Respir Med 2005; 99:976.
- Levine S, Kaiser L, Leferovich J, Tikunov B. Cellular adaptations in the diaphragm in chronic obstructive pulmonary disease. N Engl J Med 1997; 337:1799.
- Shapiro SH, Ernst P, Gray-Donald K, et al. Effect of negative pressure ventilation in severe chronic obstructive pulmonary disease. Lancet 1992; 340:1425.
- Waldhorn RE. Nocturnal nasal intermittent positive pressure ventilation with bi-level positive airway pressure (BiPAP) in respiratory failure. Chest 1992; 101:516.
- Gay PC, Patel AM, Viggiano RW, Hubmayr RD. Nocturnal nasal ventilation for treatment of patients with hypercapnic respiratory failure. Mayo Clin Proc 1991; 66:695.
- Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med 2001; 163:540.
- Tsolaki V, Pastaka C, Kostikas K, et al. Noninvasive ventilation in chronic respiratory failure: effects on quality of life. Respiration 2011; 81:402.
- Strumpf DA, Millman RP, Carlisle CC, et al. Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1991; 144:1234.
- Meecham Jones DJ, Paul EA, Jones PW, Wedzicha JA. Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD. Am J Respir Crit Care Med 1995; 152:538.
- Gay PC, Hubmayr RD, Stroetz RW. Efficacy of nocturnal nasal ventilation in stable, severe chronic obstructive pulmonary disease during a 3-month controlled trial. Mayo Clin Proc 1996; 71:533.
- Struik FM, Lacasse Y, Goldstein R, et al. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2013; :CD002878.
- Duiverman ML, Wempe JB, Bladder G, et al. Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD. Thorax 2008; 63:1052.
- McEvoy RD, Pierce RJ, Hillman D, et al. Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial. Thorax 2009; 64:561.
- Clini E, Sturani C, Rossi A, et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J 2002; 20:529.
- Casanova C, Celli BR, Tost L, et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest 2000; 118:1582.
- Muir, JF, de la Salmoniere, P, Cuvelier, A, et al. Survival of severe hypercapnic COPD under long-term home mechanical ventilation with NIPPV+oxygen versus oxygen therapy alone: preliminary results of a European multicenter study. On behalf of the NIPPV Study Group. [Abstract]. Am J Respir Crit Care Med 1999; 159:A295.
- Köhnlein T, Windisch W, Köhler D, et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med 2014; 2:698.
- Köhnlein T, Schönheit-Kenn U, Winterkamp S, et al. Noninvasive ventilation in pulmonary rehabilitation of COPD patients. Respir Med 2009; 103:1329.
- Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation--a consensus conference report. Chest 1999; 116:521.
- Windisch W, Walterspacher S, Siemon K, et al. Guidelines for non-invasive and invasive mechanical ventilation for treatment of chronic respiratory failure. Published by the German Society for Pneumology (DGP). Pneumologie 2010; 64:640.
- Theerakittikul T, Ricaurte B, Aboussouan LS. Noninvasive positive pressure ventilation for stable outpatients: CPAP and beyond. Cleve Clin J Med 2010; 77:705.
- Ferrer M, Sellarés J, Valencia M, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 2009; 374:1082.
- Windisch W, Haenel M, Storre JH, Dreher M. High-intensity non-invasive positive pressure ventilation for stable hypercapnic COPD. Int J Med Sci 2009; 6:72.
- Dreher M, Storre JH, Schmoor C, Windisch W. High-intensity versus low-intensity non-invasive ventilation in patients with stable hypercapnic COPD: a randomised crossover trial. Thorax 2010; 65:303.
- Simonds AK. Home ventilation. Eur Respir J Suppl 2003; 47:38s.
- 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
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS