Long-Term Home Non-Invasive Ventilation in Patients with Severe COPD with Hypercapnic Respiratory Failure: Impact on Long-Term Survival, Exacerbations and Mortality Related Factors.
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引用次数: 0
Abstract
Background: Non-invasive ventilation (NIV) improves outcomes in acute life-threatening hypercapnic respiratory failure due to exacerbations of COPD (ECOPD), but the benefits of long-term home NIV (LTH-NIV) for managing hypercapnic chronic respiratory failure (CRF) in COPD remain unclear.
Purpose: 1) To assess the long-term survival of severe COPD patients with hypercapnic CRF started on LTH-NIV and mortality related factors; 2) To evaluate the impact of LTH-NIV on ECOPD and hospital admissions at follow-up.
Patients and methods: COPD patients who started LTH-NIV between January 2009 and December 2018 were included. Medical records and clinical outcomes were retrospectively reviewed.
Results: Forty-four COPD patients (mean [SD] age 66.5 [10.4] years, 81.8% men) with severe airflow obstruction (mean [SD] FEV1 36 [16] % of predicted), hypercapnic CRF (mean [SD] PaCO2 60.8 [9.2] mmHg) and exacerbator phenotype (mean [IQR] moderate-severe ECOPD 3 [3] in previous year) were included. Median survival from LTH-NIV was 100.3 months. Survival at one, three and five years was 86.4%, 72.7% and 68.2%, respectively. In a multivariate Cox regression model, patients with a significantly increased risk of death were those with older age, lower absolute FVC, more hospitalisations and especially those adapted to LTH-NIV in the acute phase (HR 3.67 (IC 1.04-13), p<0.05). LTH-NIV allowed an estimated mean reduction in ECOPD of 39.7% (65.2% in hospitalisations) at 12 months and 57.4% (81% in hospitalisations) at 24 months.
Conclusion: The survival rate of COPD patients with hypercapnic CRF on LTH-NIV is currently high (>50% at 5 years). Adaptation to LTH-NIV in the stable phase is the most important prognostic determinant and should be considered especially in patients with more hospitalisations and lower FVC values. Initiation of LTH-NIV reduces moderate to severe ECOPD at follow-up.
期刊介绍：
An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals
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