Long-term non-invasive ventilation in COPD after acute-on-chronic respiratory failure.
BACKGROUND
COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation have a poor prognosis. Long-term nocturnal non-invasive ventilation (NIV) may be beneficial for these patients. We hypothesized that stable patients on long-term NIV would experience clinical worsening after withdrawal of NIV.


METHODS
We included 26 consecutive COPD patients (63 ± 6 years, 58% male, FEV(1) 31 ± 14% predicted) who remained hypercapnic after acute respiratory failure requiring mechanical ventilation. After a six month run-in period, during which all patients received NIV, they were randomised to either continue (ventilation group, n = 13) or to stop NIV (withdrawal group, n = 13). The primary endpoint was time to clinical worsening defined as an escalation of mechanical ventilation.


RESULTS
All patients remained stable during the run-in period. After randomisation the withdrawal group had a higher probability of clinical worsening compared to the ventilation group (p = 0.0018). After 12 months, ten patients (77%) in the withdrawal group, but only two patients (15%) in the ventilation group, experienced clinical worsening (p = 0.0048). Six-minute walking distance increased in the ventilation group.


CONCLUSIONS
COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation may benefit from long-term NIV.
Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD, Otto-Wagner Hospital, Vienna, Austria. georg-christian.funk@meduniwien.ac.at
Georg-Christian
GC
Funk
Marie-Kathrin
MK
Breyer
Otto Chris
OC
Burghuber
Eveline
E
Kink
Kathrin
K
Kirchheiner
Robab
R
Kohansal
Ingrid
I
Schmidt
Sylvia
S
Hartl
D000368:Aged; D002908:Chronic Disease; D003422:Critical Care; D018450:Disease Progression; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D013147:Spirometry; D016896:Treatment Outcome