Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation.
OBJECTIVE
To assess the prevalence and the impact of chronic and/or acute non-respiratory co-morbidity on short and longer-term outcome of non-invasive positive pressure ventilation (NIPPV) in acute decompensations of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF).


METHODS
An observational study in a three-bed respiratory monitoring unit in a respiratory ward of a non-university hospital.


METHODS
We grouped 120 consecutive COPD patients requiring NIPPV for AHRF (pH 7.28+/-0.05, PaO2/FIO2 ratio 192+/-63, PaCO2 78.3+/-12.3 mmHg) according to whether NIPPV succeeded (n=98) or failed (n=22) in avoiding the need for endotracheal intubation and whether alive (n=77) or dead (n=42) at 6 months.


RESULTS
The prevalence of chronic and acute co-morbidity was, respectively, 20% and 41.7%; most of the cases were cardiovascular. In-hospital NIPPV failure was greater in patients with than in those without chronic (33.3% vs. 14.6%) or acute co-morbidity (32% vs. 8.6%). Six-month mortality was worse in patients with than in those without chronic (54.2% vs. 30.5%) or more than one acute co-morbidity (66.7% vs. 30.8%). Multiple regression analysis predicted in-hospital NIPPV failure by acute co-morbidity and forced expiratory volume in 1 s, while death at 6 months was predicted by having more than one acute co-morbidity, non-cardiovascular chronic co-morbidity and Activities of Daily Living score.


CONCLUSIONS
Chronic and acute co-morbidities are common in COPD patients with AHRF needing NIPPV and their presence influences short and longer-term outcome.
Scala
Raffaele
R
U.O. Pneumologia, USL8, Ospedale S. Donato, Via Nenni 20, 52100 Arezzo, Italy.
Bartolucci
Sandra
S
Naldi
Mario
M
Rossi
Marcello
M
Elliott
Mark W
MW
D000208:Acute Disease; D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D012129:Respiratory Function Tests; D013997:Time Factors; D016896:Treatment Outcome