Real-life evaluation of NIV to CPAP switch in patients with chronic respiratory failure. A case control study.

Autor: Mathieu L; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France., Rabec C; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France., Beltramo G; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; INSERM LNC-UMR 1231, Dijon, France., Aho S; Department of Epidemiology, Dijon University Hospital, Dijon, France., Tankere P; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France., Schenesse D; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France., Chorvoz J; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France., Bonniaud P; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; INSERM LNC-UMR 1231, Dijon, France., Georges M; Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, UMR 6265 CNRS 1234 INRA, University of Bourgogne Franche-Comté, Dijon, France. Electronic address: marjolaine.georges@chu-dijon.fr.
Jazyk: angličtina
Zdroj: Respiratory medicine and research [Respir Med Res] 2024 Nov; Vol. 86, pp. 101114. Date of Electronic Publication: 2024 May 02.
DOI: 10.1016/j.resmer.2024.101114
Abstrakt: Background: Non-invasive ventilation (NIV) is a standard of care for hypercapnic chronic respiratory failure (CRF). Obstructive sleep apnea syndrome (OSA) frequently contributes to hypoventilation in CRF patients. CPAP improves hypercapnia in selected COPD and obese patients, like NIV. We aimed to describe the profile of patients switching from NIV to CPAP in a cohort of patients on long-term ventilation and to identify the factors associated with a successful switch.
Methods: In this case-control study, 88 consecutive patients who were candidates for a NIV-CPAP switch were compared with 266 controls among 394 ventilated patients treated at the Dijon University Hospital between 2015 and 2020. They followed a standardized protocol including a poly(somno)graphy recorded after NIV withdrawal for three nights. CPAP trial was performed if severe OSA was confirmed. Patients were checked for recurrent hypoventilation after 1 and 23[14-46] nights under CPAP.
Results: Patients were 53% males, median age 65 [56-74] years, and median BMI 34 [25-38.5] kg/m 2 . Sixty four percent of patients were safely switched and remained on long-term CPAP. In multivariate analysis, the probability of a NIV-CPAP switch was correlated to older age (OR: 1.3 [1.01-1.06]), BMI (OR: 1.7 [1.03-1.12]), CRF etiology (OR for COPD: 20.37 [4.2-98,72], OR for obesity: 7.31 [1.58-33.74]), circumstances of NIV initiation (OR for acute exacerbation: 11.64 [2.03-66.62]), lower pressure support (OR: 0.90 [0.73-0.92]), lower baseline PaCO 2 (OR: 0.85 [0.80-0.91]) and lower compliance (OR: 0.76 [0.64-0.90]). Among 72 patients who went home under CPAP, pressure support level was the only factor associated with the outcome of the NIV-CPAP switch, even after adjustment for BMI and age ( p = 0.01 ) with a non-linear correlation. Etiology of chronic respiratory failure, age, BMI, baseline PaCO 2 , circumstances of NIV initiation, time under home NIV or NIV compliance were not predictive of the outcome of the NIV-CPAP switch.
Conclusions: A NIV-CPAP switch is possible in real life conditions in stable obese and COPD patients with underlying OSA.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Marjolaine Georges reports a relationship with ResMed that includes: paid expert testimony. Marjolaine Georges reports a relationship with Asten Santé that includes: travel reimbursement. Marjolaine Georges reports a relationship with Oxylis that includes: speaking and lecture fees. Marjolaine Georges reports a relationship with Elivie that includes: speaking and lecture fees. Claudio Rabec reports a relationship with ResMed that includes: paid expert testimony. Claudio Rabec reports a relationship with Philips that includes: paid expert testimony. Claudio Rabec reports a relationship with Antadir that includes: travel reimbursement. Claudio Rabec reports a relationship with Asten Santé that includes: travel reimbursement. Claudio Rabec reports a relationship with Elivie that includes: speaking and lecture fees. Claudio Rabec reports a relationship with Oxylis that includes: speaking and lecture fees. Claudio Rabec reports a relationship with ASDIA that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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