Background: The use of nasal intermittent positive pressure ventilation (NIPPV) would be expected to ameliorate dyspnea, ventilatory capacity and exercise tolerance durably in individuals with hypercapnic respiratory failure secondary to restrictive thoracic disease. Objectives: The purpose of this study was to determine the short-term effect of NIPPV on respiratory muscle endurance, exercise capacity and respiratory functions in patients with chronic respiratory failure due to restrictive thoracic disease. Methods: Twelve patients with chronic ventilatory failure due to restrictive thoracic disease underwent nasal bilevel positive airway pressure (BiPAP) ventilation for 2 h a day during 15 consecutive days. The effects were assessed by spirometry, arterial blood gas analysis, 6-min walking test, sensation of dyspnea according to the American Thoracic Society dyspnea scoring scales (ATS) and surface electromyogram of the diaphragm (EMGdi) before and after the study (on day 15). Results: Nasal BiPAP reduced the ATS dyspnea score from 2.5 ± 0.9 to 1.6 ± 0.4 (p < 0.01). Distances walked in 6 min increased from 320.66 ± 93.56 to 382.41 ± 121.20 m (p < 0.05). Comparison of baseline with levels after nasal BiPAP ventilation showed a statistically significant improvement in PaCO2 (p < 0.05). Forced vital capacity increased from 35 to 50% of the predicted value (p < 0.01). There were no statistically significant reductions in the amplitude of EMGdi after the therapy. Conclusion: These results indicate that NIPPV delivered via nasal BiPAP improves respiratory functions, exercise capacity, and reduces dyspnea in the short term in patients with chronic respiratory failure due to restrictive thoracic disease. Whether such short-term improvements can be sustained merits further study.

Keywords:
NIPPV, Restrictive thoracic disease, Muscle rest, Diaphragm EMG, Pulmonary function
1.
Leger P, Bedicam JM, Cornette A: Nasal intermittent positive pressure ventilation. Chest 1994;105:100–105.
2.
Hill N, Eveloff SE, Carlisle CC: Efficacy of nocturnal nasal ventilation in patients with restrictive thoracic disease. Am Rev Respir Dis 1992;145:362–371.
3.
Carrey Z, Gottfried SB, Levy RD: Ventilatory muscle support in respiratory failure with nasal positive pressure ventilation. Chest 1990;97:150–158.
4.
Bach JR, Alba AS, Shin D: Management alternative for postpolio respiratory insufficiency. Assisted ventilation by nasal or oral-nasal interface. Am J Phys Med Rehabil 1989;68:264–271.
5.
Simmonds AK, Elliot MW, Carrol N, Branthwaite MA: Long-term nasal intermittent positive pressure ventilation: Clinical, physiological and economic outcomes (abstract). Am Rev Respir Dis 1991;143:A74.
6.
Goldstein RS, De Rosie JA, Avendano MA, Dolmage TE: Influence of noninvasive positive pressure ventilation on inspiratory muscles. Chest 1991;99:408–415.
7.
Leger P, Jennequin J, Gerard M, Robert D: Home positive pressure ventilation via nasal mask for patients with neuromuscular weakness or restrictive lung and chest-wall disease. Respir Care 1989;34:73–79.
8.
Bach JR, Alba AS: Management of chronic alveolar hypoventilation by nasal ventilation. Chest 1990;97:52–57.
9.
Meyer TJ, Hill NS: Noninvasive positive pressure ventilation to treat respiratory failure (review). Ann Intern Med 1994;120:760–770.
10.
Marino W: Intermittent volume cycled mechanical ventilation via nasal mask in patients with respiratory failure due to COPD. Chest 1991;99:681–684.
11.
Soo Hoo GW, Santiago S, Williams AJ: Nasal mechanical ventilation for hypercapnic respiratory failure in COPD: Determinants of success (abstract). Am Rev Respir Dis 1991;143:A79.
12.
Hoepner VH, Cockcroft DW, Dosman JA, Cotton DJ: Nighttime ventilation improves respiratory failure in secondary kyphoscoliosis. Am Rev Res Dis 1984;129:240–243.
13.
Bergofsky EH: Respiratory failure in disorders of the thoracic cage. Am Rev Respir Dis 1979;119:643–669.
14.
Ellis ER, Grunstein RR, Chan S, Bye PT, Sullivan CE: Noninvasive ventilatory support during sleep improves respiratory failure in kyphoscoliosis. Chest 1988;94:811–815.
15.
Nava S, Ambrosino N, Rubini F, Fracchia C, Rampulla C, Torri G, Calderini E: Effect of nasal pressure support ventilation by nasal mask in patients with stable COPD. Chest 1993;103:143–150.
16.
Renston JP, DiMarco AF, Supinski GS: Respiratory muscle rest using nasal BiPAP ventilation in patients with stable severe COPD. Chest 1994;105:1053–1060.
17.
Rochester DF, Braun NM, Laine S: Diaphragmatic energy expenditure in chronic respiratory failure. The effect of assisted ventilation with body respirators. Am J Med 1977;63:223–232.
18.
Waldhorn RE: Nocturnal nasal intermittent positive pressure ventilation with bi-level positive airway pressure (BiPAP) in respiratory failure. Chest 1992;101:516–521.
19.
Ambrosino N, Montagna T, Nava S, Negri A, Brega S, Fracchia C, Zocchi L, Rampulla C: Short term effect of intermittent negative pressure ventilation in COPD patients with respiratory failure. Eur Respir J 1990;3:502–508.
20.
Martin JG: Clinical intervention in chronic respiratory failure. Chest 1990;90(suppl):105s.
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2002
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