High-pressure NIV for acute hypercapnic respiratory failure in COPD: improved survival in a retrospective cohort study.

Autor: Hedsund C; Respiratory Medicine Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark caroline.emma.hedsund@regionh.dk., Nilsson PM; Respiratory Medicine Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.; Department of Anesthesiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark., Hoyer N; Respiratory Medicine Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.; Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark., Rasmussen DB; Pulmonary Research Unit Region Zealand (PLUZ), Department of Respiratory Medicine, Zealand Univsersity Hospital Naestved and Roskilde, Naestved, Denmark.; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark., Holm CP; Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark., Sonne TP; Respiratory Medicine Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark., Jensen JS; Respiratory Medicine Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; PERSIMUNE&CHIP: Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark., Wilcke JT; Respiratory Medicine Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.
Jazyk: angličtina
Zdroj: BMJ open respiratory research [BMJ Open Respir Res] 2022 Jun; Vol. 9 (1).
DOI: 10.1136/bmjresp-2022-001260
Abstrakt: Introduction: Updated treatment guidelines for acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) with non-invasive ventilation (NIV) in 2016 recommended a rapid increase in inspiratory positive airway pressure (IPAP) to 20 cm H 2 O with possible further increase for patients not responding. Previous guidelines from 2006 suggested a more conservative algorithm and maximum IPAP of 20 cm H 2 O.
Aim: To determine whether updated guidelines recommending higher IPAP during NIV were related with improved outcome in patients with COPD admitted with AHRF, compared with NIV with lower IPAP.
Methods: A retrospective cohort study comparing patients with COPD admitted with AHRF requiring NIV in 2012-2013 and 2017-2018.
Results: 101 patients were included in the 2012-2013 cohort with low IPAP regime and 80 patients in the 2017-2018 cohort with high IPAP regime. Baseline characteristics, including age, forced expiratory volume in 1 s (FEV 1 ), pH and PaCO 2 at initiation of NIV, were comparable. Median IPAP in the 2012-2013 cohort was 12 cm H 2 O (IQR 10-14) and 20 cm H 2 O (IQR 18-24) in the 2017-2018 cohort (p<0.001). In-hospital mortality was 40.5% in the 2012-2013 cohort and 13.8% in the 2017-2018 cohort (p<0.001). The 30-days and 1-year mortality were significantly lower in the 2017-2018 cohort. With a Cox model 1 year survival analysis, adjusted for age, sex, FEV 1 and pH at NIV initiation, the HR was 0.45 (95% CI 0.27 to 0.74, p=0.002).
Conclusion: Short-term and long-term survival rates were substantially higher in the cohort treated with higher IPAP. Our data support the current strategy of rapid increase and higher pressure.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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