Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial
| Autor: | R D, McEvoy, R J, Pierce, D, Hillman, A, Esterman, E E, Ellis, P G, Catcheside, F J, O'Donoghue, D J, Barnes, R R, Grunstein, P, Eastwood |
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| Přispěvatelé: | McEvoy, RD, Pierce, RJ, Hillman, D, Esterman, A, Ellis, EE, Catcheside, PG, O'Donoghue, FJ, Barnes, DJ, Grunstein, RR |
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Spirometry medicine.medical_specialty Vital capacity Partial Pressure medicine.medical_treatment Pressure support ventilation chest-wall positive pressure ventilation Polysomnography Hypercapnia Positive-Pressure Respiration Pulmonary Disease Chronic Obstructive FEV1/FVC ratio Forced Expiratory Volume Oxygen therapy medicine Humans sleep Aged COPD medicine.diagnostic_test business.industry Hazard ratio domicilary oxygen therapy Carbon Dioxide medicine.disease Survival Analysis Surgery respiratory tract diseases Affect Treatment Outcome Anesthesia Quality of Life hypoventilation Female business obstructive pulmonary-disease |
| Popis: | Background: Sleep hypoventilation has been proposed as a cause of progressive hypercapnic respiratory failure and death in patients with severe chronic obstructive pulmonary disease (COPD). A study was undertaken to determine the effects of nocturnal non-invasive bi-level pressure support ventilation (NIV) on survival, lung function and quality of life in patients with severe hypercapnic COPD. Method: A multicentre, open-label, randomised controlled trial of NIV plus long-term oxygen therapy (LTOT) versus LTOT alone was performed in four Australian University Hospital sleep/respiratory medicine departments in patients with severe stable smoking-related COPD (forced expiratory volume in 1 s (FEV1.0) 46 mm Hg and on LTOT for at least 3 months) and age 20/h) or morbid obesity (body mass index >40) were excluded. Outcome measures were survival, spirometry, arterial blood gases, polysomnography, general and disease-specific quality of life and mood. Results: 144 patients were randomised (72 to NIV + LTOT and 72 to LTOT alone). NIV improved sleep quality and sleep-related hypercapnia acutely, and patients complied well with therapy (mean (SD) nightly use 4.5 (3.2) h). Compared with LTOT alone, NIV (mean follow-up 2.21 years, range 0.01-5.59) showed an improvement in survival with the adjusted but not the unadjusted Cox model (adjusted hazard ratio (HR) 0.63, 95% CI 0.40 to 0.99, p = 0.045; unadjusted HR 0.82, 95% CI 0.53 to 1.25, p = NS). FEV1.0 and PaCO2 measured at 6 and 12 months were not different between groups. Patients assigned to NIV + LTOT had reduced general and mental health and vigour. Conclusions: Nocturnal NIV in stable oxygen-dependent patients with hypercapnic COPD may improve survival, but this appears to be at the cost of worsening quality of life. Refereed/Peer-reviewed |
| Databáze: | OpenAIRE |
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