Ward-based non-invasive ventilation for hypercapnic exacerbations of COPD: a 'real-life' perspective.
BACKGROUND
Non-invasive ventilation (NIV) has revolutionized the management of hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD). However, most published data have evaluated highly selected patients within the context of randomized controlled trials.


OBJECTIVE
We wished to evaluate the outcomes of ward-based NIV in 'real-life' patients admitted to hospital with a hypercapnic exacerbation of COPD.


METHODS
Retrospective data (gender, age, baseline pH, PaCO(2) and values after 1 and 4 h of NIV, and outcomes) were evaluated for all patients receiving NIV in the respiratory unit of Aberdeen Royal Infirmary from January 2006 to December 2009. Data were analysed in three groups: as a whole, in those with baseline pH >or=7.25 and baseline pH <7.25.


RESULTS
Data were available for all 392 patients commenced on ward-based NIV [45% male, mean age (range) 71 years (42-89)] with mean baseline pH of 7.24 and PaCO(2) of 10.1 kPa; respective values improved significantly (P <0.0001) following 1 and 4 h of NIV and treatment was considered successful in 66%. In those with baseline pH <7.25 and >or=7.25, the success rates of NIV were 58 and 72%, respectively.


CONCLUSIONS
In hypercapnic exacerbations of COPD, ward-based NIV is useful in the 'real-life' setting with physiological parameters improving after only a short treatment period, while two-thirds of all patients were discharged from hospital. Further data are required to help determine factors other than pH which influence the outcome of NIV.
McLaughlin
K M
KM
Department of Respiratory Medicine, Aberdeen Royal Infirmary Aberdeen, Scotland AB25 2ZN, UK. k.mclaughlin@nhs.net
Murray
I M
IM
Thain
G
G
Currie
G P
GP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006935:Hypercapnia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011175:Positive-Pressure Respiration; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies