BACKGROUND:COPD patients who remain hypercapnic after acute respiratory failure requiringmechanical 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 requiringmechanical ventilation may benefit from long-term NIV.
RCT Entities:
BACKGROUND:COPDpatients 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 COPDpatients (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:COPDpatients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation may benefit from long-term NIV.
Authors: L De Backer; W Vos; B Dieriks; D Daems; S Verhulst; S Vinchurkar; K Ides; J De Backer; P Germonpre; W De Backer Journal: Int J Chron Obstruct Pulmon Dis Date: 2011-11-18
Authors: Tim Raveling; Judith Vonk; Fransien M Struik; Roger Goldstein; Huib Am Kerstjens; Peter J Wijkstra; Marieke L Duiverman Journal: Cochrane Database Syst Rev Date: 2021-08-09
Authors: Gregorino Paone; Vittoria Conti; Giuseppe Biondi-Zoccai; Elena De Falco; Isotta Chimenti; Mariangela Peruzzi; Corrado Mollica; Gianluca Monaco; Gilda Giannunzio; Giuseppe Brunetti; Giovanni Schmid; V Marco Ranieri; Giacomo Frati Journal: Mediators Inflamm Date: 2014-05-25 Impact factor: 4.711