Reversal of Acute Exacerbations of Chronic Obstructive Lung Disease by Inspiratory Assistance with a Face Mask

PATIENTS in respiratory distress from acute exacerbations of chronic obstructive pulmonary disease often require endotracheal intubation and mechanical ventilation, both to restore adequate gas exchange and to alleviate respiratory-muscle fatigue. 1 Both endotracheal intubation and mechanical ventilation have numerous complications, 2 , 3 however, including nosocomial pneumonia, barotrauma, and tracheal injury. There is a need for methods of ventilatory assistance that could obviate the necessity for intubation in patients with acute respiratory failure. In chronic respiratory insufficiency, ventilation has been assisted noninvasively by means of external negative pressure, 4 chest-wall oscillations, 5 and positive-pressure ventilation administered through a mouthpiece 6 or through the nose. 7 , 8 Intermittent positive pressure . . .