Back to Browse Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 3 » Issue 3

Mechanisms of improvement of respiratory failure in patients with COPD treated with NIV

Authors Annabel H Nickol, Nicholas Hart, Nicholas S Hopkinson, Carl-Hugo Hamnegård, John Moxham, et al

Published 12 September 2008 Volume 2008:3(3) Pages 453—462

DOI http://dx.doi.org/10.2147/COPD.S2705

Annabel H Nickol1,2, Nicholas Hart1,3, Nicholas S Hopkinson1, Carl-Hugo Hamnegård4, John Moxham5, Anita Simonds1, Michael I Polkey1

1Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK; 2Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; 3The Lane Fox Unit, St Thomas’ Hospital, London, UK; 4Department of Pulmonary Medicine and Clinical Physiology, Sahlgrenska University, Gotenborg, Sweden; 5Respiratory Muscle Laboratory, King’s College London School of Medicine, King’s College Hospital, London, UK

Background: Noninvasive ventilation (NIV) improves gas-exchange and symptoms in selected chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure. We hypothesized NIV reverses respiratory failure by one or all of increased ventilatory response to carbon-dioxide, reduced respiratory muscle fatigue, or improved pulmonary mechanics.

Methods: Nineteen stable COPD patients (forced expiratory volume in one second 35% predicted) were studied at baseline (D0), 5–8 days (D5) and 3 months (3M) after starting NIV.

Results: Ventilator use was 6.2 (3.7) hours per night at D5 and 3.4 (1.6) at 3M (p = 0.12). Mean (SD) daytime arterial carbon-dioxide tension (PaCO2) was reduced from 7.4 (1.2) kPa to 7.0 (1.1) kPa at D5 and 6.5 (1.1) kPa at 3M (p = 0.001). Total lung capacity decreased from 107 (28) % predicted to 103 (28) at D5 and 103 (27) % predicted at 3M (p = 0.035). At D5 there was an increase in the hypercapnic ventilatory response and some volitional measures of inspiratory and expiratory muscle strength, but not isolated diaphragmatic strength whether assessed by volitional or nonvolitional methods.

Conclusion: These findings suggest decreased gas trapping and increased ventilatory sensitivity to CO2 are the principal mechanism underlying improvements in gas-exchange in patients with COPD following NIV. Changes in some volitional but not nonvolitional muscle strength measures may reflect improved patient effort.

Keywords: COPD; hypercapnic respiratory failure; NIV; pulmonary mechanics; ventilatory drive

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 

 

Readers of this article also read:

Folate-targeted paclitaxel-conjugated polymeric micelles inhibits pulmonary metastatic hepatoma in experimental murine H22 metastasis models

Zhang Y, Zhang H, Wu WB, Zhang FH, Liu S, Wang R, Sun YC, Tong T, Jing XB

International Journal of Nanomedicine 2014, 9:2019-2030

Published Date: 23 April 2014

Predicting prediabetes in a rural community: a survey among the Karen ethnic community, Thasongyang, Thailand

Lorga T, Aung MN, Naunboonruang P, Thinuan P, Praipaksin N, Deesakul T, Inwan U, Yingtaweesak T, Manokulanan P, Suangkaew S, Payaprom A

International Journal of General Medicine 2012, 5:219-225

Published Date: 1 March 2012

Laparoscopic management of a fallopian tubal torsion complicated by a large hydrosalpinx

Lim WH, Roex AJ

International Journal of Women's Health 2011, 3:381-384

Published Date: 9 November 2011

Antioxidant oils and Salmonella enterica Typhimurium reduce tumor in an experimental model of hepatic metastasis

Sorenson BS, Banton KL, Augustin LB, Leonard AS, Saltzman DA

OncoTargets and Therapy 2011, 4:59-69

Published Date: 30 May 2011

Getting the balance right: Established and emerging therapies for major depressive disorders

Bojana Perovic, Marija Jovanovic, Branislava Miljkovic, et al

Neuropsychiatric Disease and Treatment 2010, 6:343-364

Published Date: 5 July 2010

Tissue regeneration as next-generation therapy for COPD – potential applications

Shunsuke Ohnishi, Noritoshi Nagaya

International Journal of Chronic Obstructive Pulmonary Disease 2008, 3:509-514

Published Date: 5 December 2008

Preferential recruitment of neutrophils by endothelin-1 in acute lung inflammation induced by lipopolysaccharide or cigarette smoke

Tapan Bhavsar, Xing Jian Liu, Hardik Patel, Ralph Stephani, Jerome O Cantor

International Journal of Chronic Obstructive Pulmonary Disease 2008, 3:477-481

Published Date: 12 September 2008