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The Acute Effects of Nasal Positive Pressure Ventilation in Patients With Advanced Cystic Fibrosis

John T. Granton; Steven Kesten
Author and Funding Information

Affiliations: From the Toronto Hospital, University of Toronto, Toronto, Ontario,  From Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago

Affiliations: From the Toronto Hospital, University of Toronto, Toronto, Ontario,  From Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago


1998 by the American College of Chest Physicians


Chest. 1998;113(4):1013-1018. doi:10.1378/chest.113.4.1013
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Abstract

Objective: To evaluate the acute effects of noninvasive positive pressure ventilation (NPPV) in patients with stable chronic respiratory failure secondary to cystic fibrosis.

Patients: Eight patients (29±5 years of age) with severe airflow limitation (mean FEV1, 24±3% predicted) and chronic respiratory failure (PaO2=67±15 mm Hg and PaCO2=50±4 mm Hg) were evaluated.

Methods: Tidal volume, respiratory rate, minute ventilation, oxygen saturation, and transcutaneous CO2 (TcCO2) measurements were made over a 20-min period before and after the application of NPPV (inspiratory pressure of 10 to 12 cm H2O and expiratory pressure of 4 to 6 cm H2O).

Results: NPPV increased saturation from 88±2% to 90±1% (p<0.05) and decreased TcCO2 from 51±3 mm Hg to 50±2 mm Hg (p<0.05). Tidal volume increased from 219±20 mL to 256±37 mL (p=not significant [NS]) and respiratory rate decreased from 24±2 to 18±1 (p<0.01). Minute ventilation decreased from 5.3±0.8 L/min to 4.6±0.6 L/min (p=0.08). There was no change in duty cycle (32±5% to 34±5%, p=NS). In two patients, esophageal pressure measurements were also recorded. There was a decrease in pressure from −21±1 cm H2O to −11±2 cm H2O and −14±1 cm H2O to −7±1 cm H2O.

Conclusions: In patients with stable, severe cystic fibrosis, NPPV (1) acutely improves gas exchange, (2) decreases minute ventilation, suggesting either a reduction in CO2 production or an increase in alveolar ventilation, and (3) reduces work of breathing.


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