Chronic respiratory failure in patients with chronic obstructive pulmonary disease under home noninvasive ventilation: Real-life study

Abstract

Background: Home noninvasive ventilation (NIV) has been increasingly used in stable chronic obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure (CHRF). However its effectiveness remains debatable. Aim: To describe a follow-up of COPD patients under home NIV. Methods: Retrospective descriptive study based on a prospective 3-year database that included COPD patients under home NIV between August 2011 and July 2014. Results: Within the 334 patients initially screened, 109 (32.6%) had COPD with a mean ± SD post-bronchodilator FEV1 of 38.6 ± 14.9% predicted; age of 65.6 ± 9.6 years.The mean ± SD duration of ventilation was 63.4 ± 51.1 months. Heterogeneous comorbidities that can contribute to CHRF were not excluded: obstructive sleep apnea and obesity were the most prevalent.Sixty-two (56.9%) patients started NIV during admission with acute respiratory failure.During follow-up there was a significant increase in mean inspiratory positive airway pressure (IPAP) and respiratory rate (19.5 ± 4.4 vs. 23.6 ± 5.3 cmH2O and 10.7 ± 5.2 vs. 15.2 ± 1.4 breaths/min, respectively, p < 0.0001), with a significant improvement in hypercapnia (PaCO2: 52.9 ± 7.7 vs. 49.5 ± 7.5 mmHg, p < 0.0001), with 93.3% of patients compliant to NIV.Admissions and days spent in hospital for respiratory illness significantly decreased after institution of NIV (respectively, 1.2 ± 1.1 vs. 0.7 ± 1.8 and 15.0 ± 16.8 vs. 8.8 ± 19.4, p < 0.001).At final evaluation, patients with severe hypercapnia (n = 47; PaCO2 ≥50 mmHg) performing NIV at higher pressures (n = 30; IPAP ≥25 cmH2O) were more compliant (10.1 ± 3.3 vs. 6.1 ± 3.6 h/day). Three-year mortality was 24.8% (27 of 109 patients). Conclusions: This is a real-life retrospective study in COPD patients with CHRF which results suggest benefit from home NIV. For most, NIV was effective and tolerable even at high pressures. Keywords: Chronic obstructive pulmonary disease (COPD), Chronic hypercapnic respiratory failure (CHRF), Patient compliance, Noninvasive ventilation (NIV), Hospitalization