Chest
Clinical InvestigationsRESPIRATORY FAILUREIs It Safe for Patients With Chronic Hypercapnic Respiratory Failure Undergoing Home Noninvasive Ventilation To Discontinue Ventilation Briefly?
Section snippets
Patients
Eleven patients in clinically stable condition with severe CRF were included in this study. Clinical stability was defined as a lack of hospital admissions and exacerbations requiring supplemental medical therapy and no variations in ABG levels (ie, no changes≥ 5% in pH, Paco2, and Pao2) or ventilator settings in the 3 months preceding the study. All the patients had been successfully (see the next section) established on home mechanical ventilation for at least 12 months, and all of them were
Results
Figure 2illustrates the proportion of patients over time who were able to remain stable without receiving NIMV. Five of the 11 patients (45.4%) met one of the five criteria for immediate reconnection to a ventilator before the scheduled time. The reasons for reconnection were the following: an increased Paco2 level (one patient on day 4); a simultaneous increase in Paco2and decrease in pH to < 7.35 (two patients on days 3 and 5); and a simultaneous increase in Paco2 with a dyspnea score of > 5
Discussion
In this prospective study, we have shown that briefly interrupting NIMV in patients with chronic hypercapnic respiratory failure who had been successfully established in a home-care program for > 1 year causes clinical and ABG deterioration in > 40% of those patients. Sporadic discontinuation from long-term ventilation, either intentional or unintentional, is quite a common problem in clinical practice. It has been shown, for example, by Srinivasan et al16 that in the Greater Los Angeles Branch
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Supported in part by Telethon Italy grant No. 1125C.