Chronic Obstructive Lung Disease - Oxygen-Replacement Therapy

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Noninvasive Positive Pressure Ventilation (NPPV). If the patient is able to breathe naturally, oxygen is delivered through a tube using a tightly fitted oxygen mask to maintain airway pressure during breathing. Experts now believe such devices should be first-line treatments (in addition to medications) for managing respiratory failure after an acute exacerbation. They allow the patient to communicate and drink fluids and are much better tolerated than nose or throat tubes. They cannot be used on patients with rapidly deteriorating disease, who are uncooperative, or who have facial structures that do not allow the mask to make a tight seal.

Mechanical Ventilation. In very serious cases, such as acute respiratory failure, a mechanical ventilator takes over the function of breathing. The primary goal of ventilation is to eliminate carbon dioxide and restore a balanced exchange of gases with oxygen administration.

A variety of mechanical ventilators are currently in use. A 1999 study reported that mechanical ventilators that use small breaths of air reduced mortality rates by 25% compared to those that required larger breaths.

Unfortunately, most patients have a low tolerance for intubation, and the tubes are often removed prematurely because of discomfort. Painkillers, sedatives, or even muscle relaxants may be needed.

There are also several complications that cause removal of breathing tubes:

• Ejection of the tube after coughing
• Mucus plugging
• Bleeding

Removing ventilation tubes too early produces adverse events in nearly all such patients. A study found that patients may be able to go off the ventilator more quickly and safely if they are screened daily and encouraged to breathe spontaneously as soon as possible.

Review Date: 04/28/2006
Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital