Nasal intermittent positive pressure ventilation in acute exacerbations of chronic obstructive pulmonary disease--a preliminary study

Respir Med. 1993 Jul;87(5):387-94. doi: 10.1016/0954-6111(93)90054-4.


Ten patients (two male) suffering from acute exacerbations of long-standing chronic obstructive pulmonary disease and admitted in hypoxic, hypercapnic respiratory failure were treated with Nasal Intermittent Positive Pressure Ventilation (NIPPV) plus supplemental oxygen, on a general medical ward. The median (range) pH on admission was 7.30 (7.20-7.35), the median age was 67 years (47-77) with an FEV1 (percent of predicted) of 30 (17-39). On admission the median arterial oxygen tension (PaO2) was 4.71 kPa (3.45-6.26) on air, and the carbon dioxide tension (PaCO2) was 7.68 kPa (6.85-9.83). With controlled oxygen therapy there was no significant improvement in PaO2, but the median PaCO2 increased significantly to 9.75 kPa (7.04-11.70) (P < 0.05). By using NIPPV with supplemental oxygen it was possible to significantly improve the median PaO2 to 11.25 kPa (6.70-26.90) (P < 0.01) without worsening PaCO2 levels (8.96 kPa; 6.85-13.10). NIPPV was applied by a senior, respiratory physiotherapist and used intermittently depending on patient tolerance and clinical response. The median total time on NIPPV was 27 h, delivered over 1-5 days. One patient found the mask difficult to tolerate beyond a short period of time. NIPPV was well accepted on a general ward by nursing staff. Three patients later died with progressive hypercapnia, despite an initial response; with one of these patients also receiving intubation and mechanical ventilation. A further patient also received intubation and mechanical ventilation and was eventually discharged. NIPPV plus supplemental oxygen offers a method to correct hypoxaemia on a general medical ward without worsening hypercapnia for acute on chronic, hypoxic, hypercapnic respiratory failure, and warrants further investigation.

MeSH terms

  • Acute Disease
  • Aged
  • Carbon Dioxide / blood
  • Female
  • Forced Expiratory Volume
  • Humans
  • Intermittent Positive-Pressure Ventilation*
  • Lung Diseases, Obstructive / blood
  • Lung Diseases, Obstructive / physiopathology
  • Lung Diseases, Obstructive / therapy*
  • Male
  • Middle Aged
  • Oxygen / blood
  • Oxygen Inhalation Therapy
  • Respiratory Insufficiency / blood
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*


  • Carbon Dioxide
  • Oxygen