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Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD
  1. M L Duiverman1,
  2. J B Wempe1,2,
  3. G Bladder1,
  4. D F Jansen3,
  5. H A M Kerstjens1,
  6. J G Zijlstra4,
  7. P J Wijkstra1
  1. 1
    Department of Pulmonary Diseases/Department of Home Mechanical Ventilation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2
    Centre for Rehabilitation, University Medical Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  3. 3
    Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  4. 4
    Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  1. Dr M L Duiverman, Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Post Box 30001, 9700 RB Groningen, The Netherlands; m.l.duiverman{at}int.umcg.nl

Abstract

Background: Long-term non-invasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure. A study was undertaken to investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation improves health-related quality of life, functional status and gas exchange compared with pulmonary rehabilitation alone in patients with COPD with chronic hypercapnic respiratory failure.

Methods: 72 patients with COPD were randomly assigned to nocturnal NIPPV in addition to rehabilitation (n = 37) or rehabilitation alone (n = 35). Outcome measures were assessed before and after the 3-month intervention period.

Results: The Chronic Respiratory Questionnaire total score improved 15.1 points with NIPPV + rehabilitation compared with 8.7 points with rehabilitation alone. The difference of 7.5 points was not significant (p = 0.08). However, compared with 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: Non-invasive ventilation augments the benefits of pulmonary rehabilitation in patients with COPD with chronic hypercapnic respiratory failure as it improves several measures of health-related quality of life, functional status and gas exchange.

Trial registration number: NCT00135538.

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Footnotes

  • ▸ Additional Methods data are published online only at http://thorax.bmj.com/content/vol63/issue12

  • Funding: This study was funded by the Dutch Asthma Foundation.

  • Competing interests: None.

  • Ethics approval: The study was approved by the local medical ethical committee and all participants gave written informed consent to participate.

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