Psychiatric disorders as predictor of adherence to non-invasive ventilation treatment in patients with acute exacerbation in chronic obstructive pulmonary disease - a real life study.

Introduction: Non-invasive ventilation (NIV) treatment is effective and potentially lifesaving in patients with respiratory acidosis and acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, feelings of anxiety during NIV treatment are common, potentially leading to premature patient-initiated termination of treatment.The primary aim of this study is to examine whether psychiatric disorders are a risk factor of premature patient-initiated termination of NIV treatment. The secondary aim is to examine the patterns in use of sedative drugs during NIV treatment.

Methods: This retrospective cohort study includes 195 patients with AECOPD receiving NIV between 1 January and 31 December 2018, in hospitals in the Northern Region of Denmark. Information was obtained from medical records. Psychiatric disorders were defined by the use of psycholeptics at home, right before admission.Primary outcome was premature patient-initiated termination of NIV treatment. Secondary outcome was the use of any sedative drug during NIV treatment.

Results: Patient-initiated premature termination was seen in 41 (21%) of cases. This group had a significantly higher mortality (43.9% vs. 19.5% in the total population, p < 0.01). A higher risk of patient-initiated premature termination was seen in patients with psychiatric disorders (Odds ratio 2.18, p < 0.05) and older age (Odds ratio 1.06, p < 0.05). No significant difference in the use of sedative drugs was seen (34.1% vs. 38.1% in the total population, p 0.12).

Conclusion: A significantly higher risk of premature patient-initiated termination of NIV treatment was seen in patients with psychiatric disorders and older patients, but not in patients with active smoking or excessive use of alcohol. No significant difference in the pattern of sedative drug use during treatment was seen.