HIGH INTENSITY NON INVASIVE VENTILATION
High intensity NPPV is a new
strategy aim at maximal improvement in gas exchange in COPD patients with chronic
hypercapnic respiratory failure by increasing ventilator setting to the
individually tolerated maximum if necessary or to the level necessary to
achieve normocapnia.
In contrast to conventional NPPV in high intensity NPPV an
IPAP (Inspiratory positive airway pressure) is set in between 20-40 cm of H2O
initially in hospital setting and later at home. The randomised controlled
trail has shown that high intensity NPPV cause several benefit. Compare to
conventional strategy it showed-
- Improved gas exchange
- Improvement in breathing pattern and lung function
- Improvement in inspiratory muscle strength
- Increase haematocrit in anemic COPD and decrease haematocrit
in polycythemic COPD
- Improvement in dyspnea, quality of life and walking
distance.
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I wish you had expanded more on this important topic. COPD is not an unimportant disease and we are seeing a lot cases.
ReplyDeleteI would be looking forward to your experience with regards to high intensity NIPPV.
Munir
http://inspire.org.pk
I´ve been interested on high intensity NIV for a while and it is clear for now its value in Hypercapnic COPD patients. I wonder if it is as useful in non COPD patients with acute respiratory failure and if it can be installed more rapidly than the way proposed by Windish et al. Our group has treated an immunocompromised patient with P Jirovesii pneumonia that was failing to obtain benefit with traditional NIV,and a woman with dyafragmatic paresia with so to say an "acute installation" of Hihg intensity NIV that is starting with a low IPAP and programming a rise time of 1 hour to obtain a final IPAP aroud 30, always with an EPAP of 3 - 6 and a RR just below the one the patient has . We have seen a very fast amelioration of hypercapnia (when present)and hypoxemia. Though rapid, the mode has been well tolerated for patients, without barotrauma nor hemodinamic instability and we have been able to wean them after 48 hours in one case and 24 hours in the other.
ReplyDeleteI would be grateful if someone with more experience on the topic could comment on this
well noted,chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD) is normally known as the occurrence of chronic bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs in which the airways become narrowed. Following assigned points are very useful for these specific disease.
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