Lowering P CO 2 With Noninvasive Ventilation Is Associated With Improved Survival in Chronic Hypercapnic Respiratory Failure.

Autor: Jimenez JV; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut., Ackrivo J; Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania., Hsu JY; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania., Wilson MW; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut., Labaki WW; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut., Hansen-Flaschen J; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut., Hyzy RC; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut., Choi PJ; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut. pchoi@med.umich.edu.
Jazyk: angličtina
Zdroj: Respiratory care [Respir Care] 2023 Nov 25; Vol. 68 (12), pp. 1613-1622. Date of Electronic Publication: 2023 Nov 25.
DOI: 10.4187/respcare.10813
Abstrakt: Background: Chronic hypercapnic respiratory failure is associated with high mortality. Although previous work has demonstrated a mortality improvement with high-intensity noninvasive ventilation in COPD, it is unclear whether a P CO 2 reduction strategy is associated with improved outcomes in other populations of chronic hypercapnia.
Methods: The objective of this study was to investigate the association between P CO 2 reduction (by using transcutaneous P CO 2 as an estimate for P aCO 2 and survival in a broad population of individuals treated with noninvasive ventilation for chronic hypercapnia. We hypothesized that reductions in P CO 2 would be associated with improved survival. Therefore, we performed a cohort study of all the subjects evaluated from February 2012 to January 2021 for noninvasive ventilation initiation and/or optimization due to chronic hypercapnia at a home ventilation clinic in an academic center. We used multivariable Cox proportional hazard models with time-varying coefficients and P CO 2 as a time-varying covariate to test the association between P CO 2 and all-cause mortality and when adjusting for known cofounders.
Results: The mean ± SD age of 337 subjects was 57 ± 16 years, 37% women, and 85% white. In a univariate analysis, survival probability increased with reductions in P CO 2 to < 50 mm Hg after 90 d, and these remained significant after adjusting for age, sex, race, body mass index, diagnosis, Charlson comorbidity index, and baseline P CO 2 . In the multivariable analysis, the subjects who had a P aCO 2 < 50 mm Hg had a reduced mortality risk of 94% between 90 and 179 d (hazard ratio [HR] 0.06, 95% CI 0.01-0.50), 69% between 180 and 364 d (HR 0.31, 95% CI 0.12-0.79), and 73% for 365-730 d (HR 0.27, 95% CI 0.13-0.56).
Conclusions: Reduction in P CO 2 from baseline for subjects with chronic hypercapnia treated with noninvasive ventilation was associated with improved survival. Management strategies should target the greatest attainable reductions in P CO 2 .
Competing Interests: Dr Ackrivo discloses relationships with Hillrom and the National Institutes of Health National Heart, Lung and Blood Institute. Dr Labaki discloses relationships with Konica Minolta and Continuing Education Alliance. Dr Hansen-Flaschen discloses relationships with Revalesio Corporation. Dr Hyzy discloses relationships with Merck, Boehringer Ingelheim, Cour Pharmaceuticals, NOTA-Laboratories, Springer Website, UpToDate, CHEST Foundation and the NHLBI PETAL Network. Dr Choi discloses relationships with Breas Medical US. Dr Hsu discloses relationships with the National Kidney Foundation and PLOS ONE. The rest of the authors have no conflicts of interest.
(Copyright © 2023 by Daedalus Enterprises.)
Databáze: MEDLINE
Externí odkaz: