Chest
Volume 121, Issue 1, January 2002, Pages 189-195
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Clinical Investigations in Critical Care
Iron Lung vs Mask Ventilation in the Treatment of Acute on Chronic Respiratory Failure in COPD Patients: A Multicenter Study

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Study objectives

Evaluation of the effectiveness of negative-pressure ventilation (NPV) with the use of the iron lung vs noninvasive positive-pressure ventilation (NIPPV) in the treatment of COPD patients with acute on chronic respiratory failure.

Design

A retrospective case-control study.

Setting

Four Italian respiratory intermediate ICUs.

Patients

Of a total of 393 COPD patients admitted to the ICU in 1996, 53 pairs were treated with the iron lung (NPV group). Patients treated with NIPPV (NIPPV group) were matched according to mean (± SD) age (70.3 ± 7.1 vs 70.3 ± 6.9 years, respectively), sex, causes of acute respiratory failure (ARF), APACHE (acute physiology and chronic health evaluation) II score (22.4 ± 5.3 vs 22.1 ± 4.6, respectively), pH (7.26 ± 0.05 vs 7.27 ± 0.04, respectively), and Paco2 (88.1 ± 11.5 vs 85.1 ± 13.5 mm Hg, respectively) on admission to the ICU. The effectiveness of matching was 98.4%.

Results

Five patients from the NPV group (9.4%) and seven patients from the NIPPV group (13.2%) needed endotracheal intubation (EI). The treatment failure rate (ie, death and/or need of EI) was 20.7% in the NPV group and 24.5% in the NIPPV group (difference was not significant). The mean duration of mechanical ventilation (29.6 ± 28.6 vs 62.3 ± 35.7 h, respectively) and length of hospital stay (10.4 ± 4.3 vs 15 ± 5.2 d, respectively) among the 35 concordant surviving pairs were significantly lower in the NPV group than in the NIPPV group (p = 0.001 and p = 0.001, respectively).

Conclusions

These data suggest that both ventilatory techniques are equally effective in avoiding EI and death in COPD patients with ARF. Prospective trials are needed to confirm these preliminary results.

Section snippets

Study Design and Patient Selection

This matched retrospective cohort study was performed in patients with COPD who were in ARF and had been admitted to the RIICUs of Ospedale Careggi Firenze, Ospedale Forlanini Roma, Ospedale Maggiore Crema, and Ospedale Civico Palermo, over a period of 1 year, from January 1 to December 31, 1996. The patients admitted to Careggi Hospital and Forlanini Hospital who underwent NPV were designated as the NPV group. Those admitted to Crema Hospital and Palermo Hospital who underwent NIPPV were

Patients Included in the Study

Of a total of 393 patients with COPD who experienced ARF and were admitted to the RIICUs from January 1 to December 31, 1996, 53 pairs met the inclusion criteria (for either the NPV group or the NIPPV group) and were therefore evaluated. The patients reported herein included no cases of readmission to the hospital. The locations of the patients prior to admission to the RIICUs were the emergency department (NPV group, 40 patients; NIPPV group, 37 patients) and a medical ward (NPV group, 13

Discussion

The data of our study failed to demonstrate a difference in the mortality rate and treatment failure rate between patients with COPD and ARF treated with NPV and those treated with NIPPV.

This retrospective study is the first which formally compares two different noninvasive ventilatory techniques for the treatment of COPD patients experiencing ARF. A crucial factor for the validity of this study is the success in matching patients of the NPV group with those of the NIPPV group for important

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