Trends in Prevalence and Prognosis in Subjects With Acute Chronic Respiratory Failure Treated With Noninvasive and/or Invasive Ventilation

Abstract

BACKGROUND:The pattern and outcome of noninvasive ventilation (NIV) use in patients with acute or chronic respiratory disease other than COPD is not well known. The aims of this study were to investigate trends over time in underlying respiratory diseases, use of NIV, and outcomes in COPD and non-COPD patients with acute respiratory failure. METHODS: We made a retrospective analysis of data recorded prospectively from 1,113 subjects admitted between 1998 and 2012. RESULTS: Subject diagnoses were distributed as follows: COPD, n ‫؍‬ 568 (51%); bilateral bronchiectasis, n ‫؍‬ 113 (10%); obesity, n ‫؍‬ 166 (15%); chronic diffuse interstitial lung disease, n ‫؍‬ 131 (12%); restrictive pulmonary disease, n ‫؍‬ 113 (10%); and asthma, n ‫؍‬ 22 (2%). The proportion of subjects with bilateral bronchiectasis significantly decreased (OR 0.91, 95% CI 0.865-0.951, P < .001), whereas the proportion of subjects with obesity increased (OR 1.03, 95% CI 1.001-1.063, P ‫؍‬ .049) over time. The use of NIV (OR 1.05, 95% CI 1.010 -1.090, P ‫؍‬ .01) and the proportion of subjects initially treated with NIV (OR 1.05, 95% CI 1.013-1.094, P ‫؍‬ .009) increased significantly in COPD subjects only. Time trend of mortality was not significant (OR 0.98, 95% CI 0.95-1.01, P ‫؍‬ .23), whereas the severity of illness in subjects significantly increased. Transition from NIV to invasive mechanical ventilation (IMV) (OR 2.05, 95% CI 1.36 -3.11, P ‫؍‬ < .001), IMV (OR 10.49, 95% CI 4.88 -10.56, P < .001) and diffuse interstitial lung disease (OR 10.63, 95% CI 5.43-20.83, P < .001) were independently associated with death in the ICU. CONCLUSIONS: Over time, respiratory diseases have changed in non-COPD subjects and trends in the use and efficacy of NIV differ between COPD and non-COPD subjects. Mortality remained stable while the severity of illness in subjects increased. In COPD and non-COPD subjects, transition from NIV to IMV was associated with a poorer prognosis.

Trends in assisted ventilation and outcome for obstructive pulmonary disease exacerbations. A nationwide study

“…Within the last three decades especially bi-level positive airway pressure has been used in treatment of hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD). Concomitantly, the annual number of treatments with assisted ventilation given in hospitals has increased [ 2 , 3 ].…”

COPD is independently associated with 6‐month survival in patients who have life support withheld in intensive care

“…Second, according to recent studies, invasive mechanical ventilation worsens the short‐ and long‐term prognoses of patients with acute‐on‐chronic respiratory insufficiency . It also has been shown to be of no benefit in the most severe patients .…”

Noninvasive ventilation with helium–oxygen mixture in hypercapnic COPD exacerbation: aggregate meta-analysis of randomized controlled trials

“…However, real-life surveys have recently reported significantly higher failure rates than those observed by Jolliet et al in the most recent RCT, where the experienced participating teams and a potential study effect probably had a positive impact. The cost–benefit trade-off could under these conditions still lean toward the use of He/O 2 [1, 9, 23, 24]. Nonetheless, it seems unrealistic to propose He/O 2 invariably to all patients with hypercapnic COPD exacerbation [25].…”