Noninvasive Positive-Pressure Ventilation in Patients With Milder Chronic Obstructive Pulmonary Disease Exacerbations: A Randomized Controlled Trial

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OBJECTIVES: To determine the effect of the addition of noninvasive positive-pressure ventilation (NPPV) to standard medical therapy on length of hospital stay among patients presenting with mild exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospitalization. DESIGN: Randomized controlled unblinded study with concealed allocation. SETTING: Respiratory ward of a single-center, academic, tertiary-care hospital. PARTICIPANTS: Patients with a prior history of COPD who presented with a recent onset of shortness of breath and a pH of > 7.30 were eligible for inclusion in the study. INTERVENTIONS: NPPV daily for 3 days for intervals of 8, 6, and 4 hours, respectively, plus standard therapy, versus standard therapy alone. MEASUREMENTS: Borg dyspnea index at baseline, 1 hour, and daily. Length of hospital stay, endotracheal intubation, hospital survival. RESULTS: We found that NPPV was generally poorly tolerated, with only 12 of 25 patients wearing it for the prescribed 3 days. With the exception of a decrease in dyspnea at 1 hour and 2 days, significant between-group differences were not seen for any measured variable. CONCLUSIONS: The effectiveness and cost-effectiveness of the addition of NPPV to standard therapy in milder COPD exacerbations remains unclear.


Document Type: Research Article

Affiliations: 1: Department of Medicine, Royal Columbian Hospital, New Westminster, British Columbia; the Centre for Health Evaluation and Outcome Sciences, Saint Paul's Hospital and University of British Columbia, Vancouver, British Columbia; Division of Critical Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Suite 103, 250 Keary Street, New Westminster, British Columbia, V3L 5E7, Canada;, Email: 2: Division of Respiratory Medicine, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada

Publication date: May 1, 2005

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