Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study.
BACKGROUND
The effectiveness of non-invasive positive pressure ventilation (NIV) in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure (ARF) remains unclear. We investigated if nocturnal NIV in these patients prolongs the time to readmission for respiratory causes or death (primary endpoint) in the following 12 months.


METHODS
201 COPD patients admitted to hospital with ARF and prolonged hypercapnia >48 h after termination of ventilatory support were randomised to NIV or standard treatment. Secondary outcomes were daytime arterial blood gasses, transcutaneous PCO2 during the night, lung function, health-related quality-of-life (HRQL), mood state, daily activities and dyspnoea.


RESULTS
1 year after discharge, 65% versus 64% of patients (NIV vs standard treatment) were readmitted to hospital for respiratory causes or had died; time to event was not different (p=0.85). Daytime PaCO2 was significantly improved in NIV versus standard treatment (PaCO2 0.5 kPa (95% CI 0.04 to 0.90, p=0.03)) as was transcutaneous PCO2 during the night. HRQL showed a trend (p=0.054, Severe Respiratory Insufficiency questionnaire) in favour of NIV. Number of exacerbations, lung function, mood state, daily activity levels or dyspnoea was not significantly different.


CONCLUSIONS
We could not demonstrate an improvement in time to readmission or death by adding NIV for 1 year in patients with prolonged hypercapnia after an episode of NIV for ARF. There is no reason to believe the NIV was not effective since daytime PaCO2 and night-time PCO2 improved. The trend for improvement in HRQL favouring NIV we believe nevertheless should be explored further.


BACKGROUND
NTR1100.
Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
F M
FM
Struik
Department of Respiratory Medicine/Center of Home Mechanical Ventilation Maastricht, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
R T M
RT
Sprooten
Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
H A M
HA
Kerstjens
Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
G
G
Bladder
Department of Intensive Care/Center for Home Mechanical Ventilation, University Medical Centre, Erasmus MC, Rotterdam, The Netherlands.
M
M
Zijnen
Department of Pulmonology, Amphia Hospital, Breda, The Netherlands.
J
J
Asin
Department of Respiratory Medicine/Center of Home Mechanical Ventilation Maastricht, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
N A M
NA
Cobben
Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Department of Epidemiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
J M
JM
Vonk
Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
P J
PJ
Wijkstra
D000208:Acute Disease; D000339:Affect; D000368:Aged; D001784:Blood Gas Analysis; D002245:Carbon Dioxide; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D063087:Noninvasive Ventilation; D010313:Partial Pressure; D010359:Patient Readmission; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D011788:Quality of Life / Q000523:psychology; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy; D013997:Time Factors
D002245:Carbon Dioxide
COPD Exacerbations; COPD epidemiology; Non invasive ventilation