American Journal of Respiratory and Critical Care Medicine

An 80-year-old woman was admitted for severe acute-on-chronic hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. She was on aerosolized anticholinergics, anticoagulants for chronic atrial fibrillation, and levothyroxine for hypothyroidism. She received noninvasive ventilation (NIV) in addition to standard medical treatment. NIV, via oronasal mask, improved gas exchange and was applied almost continuously for the first 48 hours, and then 12 to 16 hours/day for the next 48 hours. On Day 1, SpO2 remained constantly above 90% during wakefulness; while showing recurrent dips during sleep, secondary to Cheyne-Stokes respiration (Figure 1A). To exclude that Cheyne-Stokes respiration was related to concurrent heart failure, an echocardiography was performed, which showed no left ventricular dysfunction. As the patient improved, Cheyne-Stokes respiration disappeared (Figure 1B). The patient was discharged from the hospital on Day 8.

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American Journal of Respiratory and Critical Care Medicine

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