Impact of outpatient adaptation to home mechanical ventilation on health-related quality of life in patients with chronic obstructive pulmonary disease: the OutVent study

C. Ribeiro, C. Jácome, Pedro Oliveira, Manuel Luján, S. Conde
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Abstract

Home mechanical ventilation (HMV) is indicated in patients with severe hypercapnic chronic obstructive pulmonary disease (COPD). Initiation of HMV commonly occurs during an inpatient period, but there has been increasing interest for outpatient adaptation.This study aimed to evaluate the outpatient initiation and adaptation of HMV and its impact on health-related quality of life (HRQoL) in patients with severe COPD.A single group pretest-posttest study was conducted in an Outpatient Ventilation Clinic of a tertiary hospital in Portugal. Severe COPD patients with symptoms of chronic respiratory failure with daytime pCO2≥50 mmHg in stable condition or persistent hypercapnia ≥53 mmHg >14 days following an exacerbation with mechanical ventilation were included. After 3-months of HMV, patients completed the Severe Respiratory Insufficiency (SRI), the S3-non-invasive ventilation (S3-NIV) and a patient-experience questionnaire.Fifty-three patients (73.6% male, median 71 [p25-p75 61–77] years.), with a median FEV1of 35 [29–40] % and a median baseline pCO2of 53.5 [51.9–56.5] mmHg completed the study. At 3 months patients had a median HMV usage of 6.5 h and decreased their pCO2by 6.0 mmHg. After 3 months, there was a significant improvement in the SRI Summary Scale (+5.7), above the minimal clinically import difference of 5. Patients who used HMV more than 5 h had higher S3-NIV total score (6.8versus5.7, p=0.04) and S3-NIV Sleep & NIV related side effects subscore (7.1versus5.7, p=0.03).Our findings might indicate that outpatient initiation and adaptation of HMV has a positive impact in short-term HRQoL in patients with COPD and that that this approach is perceived as a positive experience by the patients.
门诊病人适应家用机械通气对慢性阻塞性肺病患者健康相关生活质量的影响:OutVent 研究
家庭机械通气(HMV)适用于严重高碳酸血症慢性阻塞性肺病(COPD)患者。本研究旨在评估家庭机械通气的门诊启动和适应情况及其对重度慢性阻塞性肺疾病患者健康相关生活质量(HRQoL)的影响。葡萄牙一家三级医院的门诊通气诊所开展了一项单组前测后测研究。研究对象包括严重慢性阻塞性肺疾病患者,这些患者均有慢性呼吸衰竭症状,病情稳定时日间 pCO2≥50 mmHg,或在机械通气加重后 14 天内持续高碳酸血症≥53 mmHg。53 名患者(73.6% 为男性,中位数为 71 [p25-p75 61-77] 岁)完成了研究,他们的 FEV1 中位数为 35 [29-40] %,pCO2 基线中位数为 53.5 [51.9-56.5] mmHg。3 个月后,患者使用 HMV 的中位时间为 6.5 小时,pCO2 下降了 6.0 mmHg。3 个月后,SRI 总量表有了显著改善(+5.7),超过了最小临床意义差异 5。使用 HMV 超过 5 小时的患者的 S3-NIV 总分(6.8:5.7,P=0.04)和 S3-NIV 睡眠与 NIV 相关副作用子分数(7.1:5.7,P=0.03)均较高。我们的研究结果可能表明,门诊患者开始和适应 HMV 对慢性阻塞性肺病患者的短期 HRQoL 有积极影响,而且患者认为这种方法是一种积极的体验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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