Introduction Despite strong evidence for the use of Non-invasive ventilation (NIV) in acute exacerbations of COPD resulting in decompensated type 2 respiratory failure (T2RF), the evidence for the long-term use of nocturnal NIV to prevent readmission or improve survival is controversial and has often been contradictory. Therefore clinicians are faced with the difficult question of what to do with COPD patients who are admitted with severe exacerbations requiring NIV and are considered at high risk of future decompensation. We hypothesised that domiciliary nocturnal NIV, established following an acute admission with decompensated T2RF delayed readmission.
Methods We performed a retrospective case note analysis of patients started on domiciliary NIV following acute admission to a busy central London acute trust. Indication for NIV and success of treatment were assessed. Time between admissions prior to establishing domiciliary NIV and time to 1st readmission were compared.
Results 18 patients were identified from our database. (2 were excluded: 1 returned their machine immediately, the other never attended for any follow-up at our hospital.) To our knowledge the patients were not admitted to other hospitals in the year pre or post the index admission – the admission at which NIV was initiated. The mean age of the 16 remaining patients was 70 ± 12 years; 9 were female, 8 male. Indication for NIV in 13 patients was COPD with resistant or recurrent T2RF, 1 had COPD plus sarcoidosis and the remaining 2 had COPD plus obesity hypoventilation. NIV was shown to be successful in reducing pCO2 between discharge and first follow up (mean reduction 0.84 ± 1.17 kPa p = 0.01). There was a trend towards delayed 1st readmission following initiation of NIV, when compared to the time between previous admission (Kaplan-meier survival analysis. p = 0.09 Figure 1).
Conclusion Domiciliary NIV for high risk patients with decompensated T2RF in COPD is often used because of concerns of leaving the condition untreated when objectively NIV improved the patient’s pCO2 furthermore there are no consistently ratified guidelines. The data presented here suggest that NIV may help to delay readmission to hospital. The results of ongoing randomised trials are eagerly awaited.
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