Effectiveness of treatment with domiciliary nocturnal noninvasive
positive pressure ventilation is analyzed in a group of patients with chronic alveolar
hypoventilation of different etiologies. It was applied with two levels of pressure (BiPAP) via nasal mask. Criteria for evaluation were symptomatology and improvement in gas exchange. Data were analyzed by Student t tests. A total of 13 patients were included, mean age 55.7 range 20 to 76 years (5 male 8 female). Main diagnosis was
tuberculosis in 6, four of them having had
surgical procedure (
thoracoplasty 2, frenicectomy 1 and neumonectomy 1),
myopathy 3 (
myasthenia gravis 1,
muscular dystrophy 1 and
diaphragmatic paralysis 1),
obesity-hypoventilation syndrome 1, escoliosis 1,
bronchiectasis 1 and
cystic fibrosis 1. These last two patients were on waiting list for
lung transplantation. At the moment of consultation, the symptoms were: dysnea 13/13 (100%), astenia 13/13 (100%), hypersomnolency 10/13 (77%), cephalea 9/13 (69%), leg
edema 6/13 (46%), loss of memory 6/13 (46%). Regarding gas exchange, they showed
hypoxemia and
hypercapnia. Mean follow up was of 2.2 years (range 6 months to 4 years). Within the year, all 13 patients became less dyspneic. Astenia, hypersomnolency, cephalea, leg
edema and
memory loss disappeared. Improvement in gas exchange was: PaO2/FiO2 from 269 +/- 65.4 (basal) to 336.7 +/- 75.3 post-treatment (p = 0.0018). PaCO2 from 70.77 +/- 25.48 mmHg (basal) to 46.77 +/- 8.14 mmHg (p = 0.0013). Ventilatory support was discontinued en 5 patients: three because of
pneumonia requiring intubation and conventional
mechanical ventilation, two of them died and one is still with
tracheostomy; One patient with
bronchiectasis and one with
cystic fibrosis were transplanted. The remaining eight patients are stable. In conclusion, chronic alveolar
hypoventilation can be effectively treated with domiciliary nocturnal
noninvasive ventilation. Long term improvement in symptomatology and arterial blood
gases can be obtained without significant complications.