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Original article
Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study
  1. F M Struik1,2,
  2. R T M Sprooten3,
  3. H A M Kerstjens1,2,
  4. G Bladder1,
  5. M Zijnen4,
  6. J Asin5,
  7. N A M Cobben3,
  8. J M Vonk2,6,
  9. P J Wijkstra1,2
  1. 1Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
  2. 2Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
  3. 3Department of Respiratory Medicine/Center of Home Mechanical Ventilation Maastricht, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
  4. 4Department of Intensive Care/Center for Home Mechanical Ventilation, University Medical Centre, Erasmus MC, Rotterdam, The Netherlands
  5. 5Department of Pulmonology, Amphia Hospital, Breda, The Netherlands
  6. 6Department of Epidemiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
  1. Correspondence to F M Struik, Department of Pulmonary Diseases/Home Mechanical Ventilation, University Medical Center Groningen, Triadegebouw AA62, Groningen 9713 GZ, The Netherlands; f.m.struik{at}umcg.nl

Abstract

Introduction The effectiveness of non-invasive positive pressure ventilation (NIV) in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure (ARF) remains unclear. We investigated if nocturnal NIV in these patients prolongs the time to readmission for respiratory causes or death (primary endpoint) in the following 12 months.

Methods 201 COPD patients admitted to hospital with ARF and prolonged hypercapnia >48 h after termination of ventilatory support were randomised to NIV or standard treatment. Secondary outcomes were daytime arterial blood gasses, transcutaneous PCO2 during the night, lung function, health-related quality-of-life (HRQL), mood state, daily activities and dyspnoea.

Results 1 year after discharge, 65% versus 64% of patients (NIV vs standard treatment) were readmitted to hospital for respiratory causes or had died; time to event was not different (p=0.85). Daytime PaCO2 was significantly improved in NIV versus standard treatment (PaCO2 0.5 kPa (95% CI 0.04 to 0.90, p=0.03)) as was transcutaneous PCO2 during the night. HRQL showed a trend (p=0.054, Severe Respiratory Insufficiency questionnaire) in favour of NIV. Number of exacerbations, lung function, mood state, daily activity levels or dyspnoea was not significantly different.

Discussions We could not demonstrate an improvement in time to readmission or death by adding NIV for 1 year in patients with prolonged hypercapnia after an episode of NIV for ARF. There is no reason to believe the NIV was not effective since daytime PaCO2 and night-time PCO2 improved. The trend for improvement in HRQL favouring NIV we believe nevertheless should be explored further.

Trial registration number NTR1100.

  • COPD Exacerbations
  • Non invasive ventilation
  • COPD epidemiology
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