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Long-term non-invasive ventilation in COPD after acute-on-chronic respiratory failure.

Abstract：

BACKGROUND:COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation have a poor prognosis. Long-term nocturnal non-invasive ventilation (NIV) may be beneficial for these patients. We hypothesized that stable patients on long-term NIV would experience clinical worsening after withdrawal of NIV. METHODS:We included 26 consecutive COPD patients (63 ± 6 years, 58% male, FEV(1) 31 ± 14% predicted) who remained hypercapnic after acute respiratory failure requiring mechanical ventilation. After a six month run-in period, during which all patients received NIV, they were randomised to either continue (ventilation group, n = 13) or to stop NIV (withdrawal group, n = 13). The primary endpoint was time to clinical worsening defined as an escalation of mechanical ventilation. RESULTS:All patients remained stable during the run-in period. After randomisation the withdrawal group had a higher probability of clinical worsening compared to the ventilation group (p = 0.0018). After 12 months, ten patients (77%) in the withdrawal group, but only two patients (15%) in the ventilation group, experienced clinical worsening (p = 0.0048). Six-minute walking distance increased in the ventilation group. CONCLUSION:COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation may benefit from long-term NIV.

journal_name

Respir Med

journal_title

Respiratory medicine

authors

Funk GC,Breyer MK,Burghuber OC,Kink E,Kirchheiner K,Kohansal R,Schmidt I,Hartl S

doi

10.1016/j.rmed.2010.09.005

subject

Has Abstract

pub_date

2011-03-01 00:00:00

pages

427-34

issue

3

eissn

0954-6111

issn

1532-3064

pii

S0954-6111(10)00391-4

journal_volume

105

pub_type

杂志文章,随机对照试验

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