High-intensity non-invasive positive pressure ventilation for stable hypercapnic COPD

Int J Med Sci. 2009;6(2):72-6. doi: 10.7150/ijms.6.72. Epub 2009 Feb 27.


Background: The objective of the present analysis is to describe the outcomes of high-intensity non-invasive positive pressure ventilation (NPPV) aimed at maximally decreasing PaCO(2) as an alternative to conventional NPPV with lower ventilator settings in stable hypercapnic COPD patients.

Methods: Physiological parameters, exacerbation rates and long-term survival were assessed in 73 COPD patients (mean FEV(1) 30+/-12 %predicted) who were established on high-intensity NPPV due to chronic hypercapnic respiratory failure between March 1997 and May 2006.

Results: Controlled NPPV with breathing frequencies of 21+/-3 breath/min and mean inspiratory/expiratory positive airway pressures of 28+/-5/5+/-1 cmH(2)O led to significant improvements in blood gases, lung function and hematocrit after two months. Only sixteen patients (22%) required hospitalisation due to exacerbation during the first year, with anaemia increasing the risk for exacerbation. Two- and five-year survival rates of all patients were 82% and 58%, respectively. The five year survival rate was 32% and 83% in patients with low (< or =39%) and high (> or =55%) hematocrit, respectively.

Conclusion: High-intensity NPPV improves blood gases, lung function and hematocrit, and is also associated with low exacerbation rates and a favourable long-term outcome. The current report strongly emphasises the need for randomised controlled trials evaluating the role of high-intensity NPPV in stable hypercapnic COPD patients.

Keywords: COPD; exacerbation; hematocrit; non-invasive ventilation; survival.

MeSH terms

  • Aged
  • Carbon Dioxide / blood*
  • Carbon Dioxide / metabolism
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Hematocrit
  • Hemoglobins / analysis
  • Humans
  • Hypercapnia / blood
  • Hypercapnia / etiology
  • Hypercapnia / therapy
  • Male
  • Middle Aged
  • Positive-Pressure Respiration / methods*
  • Practice Guidelines as Topic
  • Pulmonary Disease, Chronic Obstructive / blood*
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Pulmonary Gas Exchange
  • Respiration
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Vital Capacity


  • Hemoglobins
  • Carbon Dioxide