We describe the use of an endoscopy face mask with a perforated membrane, which allows a nasogastric tube for continuous noninvasive ventilation in acute hypercapnic respiratory failure, in 2 patients who developed gastric distention. This interface was able to avoid most nonintentional leaks through the mask, as compared with a conventional approach, improving ventilation efficiency. To our k...

A patient who had undergone bilateral carotid body resection five years earlier for palliation of chronic airflow obstruction was found to have severe obstructive sleep apnea. He presented with hypercapnic respiratory failure, which improved after tracheostomy. A physiologic mechanism is proposed to explain this association. Previously reported studies of anesthetized animals suggest that loss ...

Introduction Noninvasive ventilation (NIV) represents the standard of care for patients with exacerbation of chronic obstructive pulmonary disease. However, NIV fails in almost 40% of the most severe forms of acute hypercapnic respiratory failure and patients must undergo endotracheal intubation and invasive ventilation. Such transition from NIV to invasive ventilation is associated to increase...

A case is described of tracheobronchomegaly progressing to extensive tracheomalacia, complicated by episodic choking, recurrent pulmonary infections, and irreversible hypercapnic respiratory failure. A Y-shaped tracheobronchial stent was placed endoscopically to splint the trachea open, with excellent clinical and physiological improvement. New stent designs may provide long term palliation in ...

Important advances have been made over the past decade towards understanding the optimal approach to ventilating patients with acute respiratory failure. Evidence now supports the use of noninvasive positive pressure ventilation in selected patients with hypercapnic respiratory failure and chronic obstructive pulmonary disease, cardiogenic pulmonary edema, and for facilitating the discontinuati...

OBJECTIVE A case series evaluating the acute effects of noninvasive positive pressure ventilation (NPPV) in patients with chronic hypercapnic respiratory failure (HRF) secondary to interstitial lung diseases (ILD). PATIENTS AND METHODS Ten patients with ILD were retrospectively evaluated. All had restrictive lung function (mean TLC, 47.6+/-12.6% predicted) and chronic hypercapnic respiratory ...

Abbreviations: chronic obstructive pulmonary disease, COPD; chronic hypercapnic respiratory failure, CHRF; noninvasive ventilation, NIV; inspiratory positive airway pressure, IPAP; breathing frequencies, BF; health-related quality of life, HRQoL; partial arterial carbon dioxide pressure, PACO2 Citation: Duiverman ML, Wijkstra PJ. Editorial. Long-term noninvasive ventilation in COPD: is high-int...

In the present commentary I review some current therapeutic debates. Is noninvasive ventilation going to become the gold standard for acute hypercapnic respiratory failure, and if we have to intubate and ventilate then what is the gold standard for sedation? Old therapies are challenged (e.g. diuretics may worsen outcome) and new ones suggested (e.g. some critically ill patients may benefit fro...

Introduction Recent evidence suggests low-flow extracorporeal CO2 removal (ECCO2-R) systems as safe and promising adjunctive therapy to avoid endotracheal intubation and the related negative consequences in subjects with severe hypercapnic respiratory failure [1]. In high-flow extracorporeal membrane oxygenation systems heterogeneous coagulation disorders are a well-known complication. However,...

BACKGROUND Chronic obstructive pulmonary disease (COPD) patients are very sensitive to changes in pulmonary mechanics and central ventilation control during sleep and may develop significant gas exchange alterations with increased hypoxemia and hypercapnia. Oxygen therapy improves nocturnal desaturation but can worsen hypoventilation. OBJECTIVES To analyze the prevalence of nocturnal hypovent...