Outcome of COPD patients performing nocturnal non-invasive mechanical ventilation

Abstract

The role of non-invasive nocturnal domiciliary ventilation (NNV) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnia is still discussed. The aims of this study were to evaluate the long-term survival, the clinical effectiveness and side-effects of NNV in these patients. Forty-nine stable hypercapnic COPD patients on long-term oxygen therapy (LTOT) were assigned to two groups: in Group 1, 28 patients performed NNV by pressure support modality in addition to LTOT; in Group 2, 21 patients continued their usual LTOT regimen. Treatment was assigned according to the compliance to NNV, after an in hospital period. Mortality rate, hospital stay (HS) and ICU admissions (IA) were recorded in the two groups. HS and IA were compared to those recorded in a similar period of follow-back. Lung and respiratory muscle function, dyspnoea, and exercise capacity (by 6-min walk test) were evaluated baseline and every 3-6 months up to 3 yr. Mean follow-up time was 35 +/- 7 months. Mortality rate was not different between the two groups: 16, 33, 46% and 13, 28, 50% at 1, 2 and 3 yr in Groups 1 and 2 respectively. Lung and respiratory muscle function did not significantly change over time. A significant increase in 6-min walk test (from 245 +/- 78 to 250 +/- 88, 291 +/- 75, 284 +/- 89 m after 1, 2 and 3 yr respectively, P < 0.01) was observed only in patients undergoing NNV. In comparison to the follow back HS significantly decreased in both groups (from 37 +/- 29 to 15 +/- 12 and from 32 +/- 18 to 17 +/- 11 days/pt/yr in Groups 1 and 2 respectively, P < 0.001) whereas IA significantly decreased only in patients performing also NNV (from 1.0 +/- 0.7 to 0.2 +/- 0.3/pt/yr, P < 0.0001). Addition of NNV by pressure support modality to LTOT does not improve long term survival but significantly reduces ICU admissions and improves exercise capacity in severe COPD with hypercapnia.

Nonpharmacological treatment and relief of symptoms in COPD: Table 1—

“…An Italian 2-yr multicentric trial showed that NPPV plus LTOT improved daytime Pa,CO 2 , dyspnoea and QoL, although survival was similar to that in the control (LTOT alone) group [84]. In this and another observational controlled study [85], ICU admissions were reduced during NPPV compared with the LTOT regimen. In one randomised controlled study, home nocturnal NPPV, added to daytime exercise training, significantly increased exercise capacity and QoL compared with exercise training alone [86].…”

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

“…Most studies provided no information. One RCT 92 stated that all patients had had previous exacerbations and three non-randomised controlled studies in stable populations 89,93,94 specified at least one previous admission because of severe exacerbation.…”

“…76,78,81,84,92 Only four out of nine 89,[93][94][95] non-randomised controlled studies provided clear details.…”

“…Of the 10 controlled studies, five 89,[93][94][95][96] had a prospective design and five appeared to be retrospective analyses of data, although this was not always clearly described. One prospective study 89 used a matched design, which may result in more similar groups at baseline and thus less biased results.…”

“…because of mask intolerance) or did not want to continue; however, in three retrospective studies, 86,88,97 levels of blood gases determined eligibility for NIV, and one retrospective study 98 gave no details. All prospective studies 89,[93][94][95][96] and one of the retrospective studies 98 gave details on similarity between NIV and usual-care groups in terms of baseline characteristics, and there appeared to be no major differences. There were no details in one retrospective study, 87 and the other three may have differences in blood gas levels as these determined eligibility for NIV.…”