8(th) International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F.; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A.; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

Although home NPPV is widely accepted for the treatment of chronic hypercapnia due to respiratory or neuromuscular disease, whether stable hypercapnic COPD patients should routinely be offered this therapy is still discussed [48] . Recently, the role of ventilator management on physiological parameters and outcome in stable hypercapnic COPD patients has become more evident. It is suggested that its benefits depend on the ability of NPPV to substantially reduce PaCO 2 through using "high" inflation pressures [49] . This was confirmed by prospective trials, showing an advantage of high over lower inspiratory pressure levels, with regard to improvements of lung function, blood gases, exerciseinduced dyspnoea and health status [50, 51] . A multicenter study showed a highly significant survival advantage of NPPV (compared with standard care) when it was targeted to maximize hypercapnia reduction [52] . The findings of that study may influence the attitude of clinicians on the use of NPPV in patients with stable hypercapnic COPD. However, the effect of elective home NPPV on exacerbation frequency in stable hypercapnic COPD remains to be determined.