Noninvasive positive pressure ventilation in the process of respiratory discontinuation in an elderly patient with chronic obstructive pulmonary disease: a case report

Zygmunt Chodorowski, Jacek Sein Anand, Marek Wisniewski

Summary
The authors report the case of a 66-year old patient with exacerbated chronic obstructive pulmonary disease in whom noninvasive positive pressure ventilation (NPPV) was used for weaning him from mechanical ventilation. In view of respiratory acidosis, hypercapnia, hypoxaemia, laboured breathing, and progressively impaired consciousness, invasive ventilation was performed. On stabilized condition and repeated discontinuation of mechanical ventilation with the SIMV and PSV modes, and following a two-hour positive spontaneous breathing trial (SBT), extubation was carried out on the 6th treatment day. Due to progressively impaired respiratory function, there was a need for reintubation and continuation of invasive ventilation. Since the previous attempt failed, the second extubation was followed by noninvasive positive pressure ventilation using the BiPAP Harmony device (parameters: IPAP 20 cm H20, EPAP 5 cm H20, respiratory rate 10/min, inspiratory phase 1.5 sec, increasing inspiratory time 600 msec). The patient required a continous NPPV for 72 hours, after which he was smoothly weaned from the device, and transferred to a medical ward. Conclusion: noninvasive positive pressure ventilation seems to be a safe procedure facilitating discontinuation of invasive ventilation in elderly patients with exacerbations of chronic obstructive pulmonary disease. It is particularly important in patients, in whom apparently successful conventional weaning is followed by a markedly impaired respiratory function after extubation.

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