Non-Invasive Nocturnal Mechanical Ventilation: Is it Feasible for COPD Patients?

Nocturnal intermittent mechanical ventilation, using negative or positive pressure devices, improves arterial blood gas tensions during spontaneous ventilation in patients with respiratory failure caused by chest wall deformities or neuromuscular disease. Similar results have been reported in short-term studies of hospitalized patients with chronic obstructive pulmonary disease (COPD). The improvement in arterial blood gas tensions in COPD has usually been ascribed to improved carbon dioxide (CO2) sensitivity and/or respiratory muscle strength. Nocturnal intermittent mechanical ventilation has been demonstrated to maintain normocapnia during the night and is thought to relieve chronic fatigue by resting respiratory muscles, allowing them to perform more mechanical work with the same amount of load [1]. However, despite these postulations, chronic fatigue has never actually been demonstrated in stable hypercapnic COPD patients. This chapter will explore: 1) Why non-invasive nocturnal mechanical ventilation should be considered for the treatment of COPD patients with chronic hypercapnia; 2) The mechanisms by which it can be effective in reversing chronic ventilatory failure; and 3) The clinical applications of non-invasive nocturnal mechanical ventilation in COPD patients.