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Nocturnal noninvasive ventilation in addition to rehabilitation in hypercapnic COPD patients
  1. Marieke L Duiverman (m.l.duiverman{at}int.umcg.nl)
  1. University Medical Center Groningen, University of Groningen, Netherlands
    1. Johan B Wempe (j.b.wempe{at}int.umcg.nl)
    1. University Medical Center Groningen, University of Groningen, Netherlands
      1. Gerrie Bladder (g.bladder{at}int.umcg.nl)
      1. University Medical Center Groningen, University of Groningen, Netherlands
        1. Désirée F Jansen (d.f.jansen{at}epi.umcg.nl)
        1. University Medical Center Groningen, University of Groningen, Netherlands
          1. Huib A.M. Kerstjens (h.a.m.kerstjens{at}int.umcg.nl)
          1. University Medical Center Groningen, University of Groningen, Netherlands
            1. Jan G Zijlstra (j.g.zijlstra{at}int.umcg.nl)
            1. University Medical Center Groningen, University of Groningen, Netherlands
              1. Peter J Wijkstra (p.j.wijkstra{at}int.umcg.nl)
              1. University Medical Center Groningen, University of Groningen, Netherlands

                Abstract

                Rationale: Long-term noninvasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in severe COPD patients with chronic respiratory failure.

                Objective: To investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation as compared to pulmonary rehabilitation alone improves health-related quality of life, functional status, and gas exchange in COPD patients with chronic hypercapnic respiratory failure.

                Measurements: Seventy-two COPD patients were randomly assigned to nocturnal NIPPV in addition to rehabilitation (n=37) or rehabilitation alone (n=35). Before and after the 3-months intervention period outcome measures were assessed.

                Results: The Chronic Respiratory Questionnaire total score improved 15.1 points with NIPPV + rehabilitation, compared to 8.7 points with only rehabilitation. The difference of 7.5 points was not significant (p=0.08). However, compared to rehabilitation alone, the difference in the fatigue domain was greater with NIPPV + rehabilitation (mean difference 3.3 points, p<0.01), as was the improvement in the Maugeri Respiratory Failure questionnaire total score (mean difference -10%, p<0.03) and its cognition domain (mean difference -22%, p<0.01). Furthermore, the addition of NIPPV improved daytime arterial carbon dioxide pressure (mean difference -0.3 kPa; p<0.01), and daily step count (mean difference 1269 steps/ day, p<0.01). This was accompanied by an increased daytime minute ventilation (mean difference 1.4 L; p<0.001).

                Conclusion: Noninvasive ventilation augments the benefits of pulmonary rehabilitation in COPD patients with chronic hypercapnic respiratory failure as it improves several measures of health-related quality of life, functional status, and gas exchange.

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