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      Long-term non-invasive ventilation for stable chronic hypercapnic COPD

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          ABSTRACT

          Introduction: Long-term non-invasive ventilation (LTNIV) for the stable hypercapnic chronic obstructive pulmonary disease (COPD)-patients have been a subject of much debate in the last two decades. The aim of this study was to compile the current knowledge on LTNIV in order to evaluate the effects on mortality and hypercapnia.

          Methods: Literature search in Pubmed, Ovid, and Embase for RCTs in Humans from January 2000 through January 2019 in written English.

          Results: Six studies with a total of 861 patients were included. LTNIV in stable hypercapnic COPD patients significantly reduced PaCO 2 but only one study found significant reduction in mortality.

          Conclusion: Our meta-analyses demonstrate that LTNIV significantly reduced PaCO 2 in stable patients with chronic hypercapnic respiratory failure compared to standard care alone, and subgroup analyses on studies with a predefined plan for ventilation, showed a considerable trend towards significant reduction in mortality.

          The take home messages on LTNIV in stable hypercapnic COPD are:

          1. It is essential that the patients have stable chronic hypercapnia.

          2. The degree of stability can best be assessed after a minimum of 2 weeks following an acute hypercapnic respiratory failure (AHRF).

          3. It is important to ventilate the patient with the goal to reduce PaCO 2 by at least 20% or below 6.5 kPa.

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          Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation : A Randomized Clinical Trial

          Patrick B. Murphy, Sunita Rehal, Gill Arbane … (2017)
          Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death.
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            Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial.

            Joseph D. Hillman, P Catcheside, A Esterman … (2009)
            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. 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. 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. 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. ACTRN12605000205639.
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              High-intensity versus low-intensity non-invasive ventilation in patients with stable hypercapnic COPD: a randomised crossover trial.

              Claudia Schmoor, Michael Dreher, Jan Storre … (2010)
              The conventional approach of low-intensity non-invasive positive pressure ventilation (NPPV) produces only minimal physiological and clinical benefits in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). To determine whether the novel approach of high-intensity NPPV is superior to low-intensity NPPV in controlling nocturnal hypoventilation. A randomised controlled crossover trial comparing 6 weeks of high-intensity NPPV (using controlled ventilation with mean inspiratory pressures of 28.6+/-1.9 mbar) with low-intensity NPPV (using assisted ventilation with mean inspiratory pressures of 14.6+/-0.8 mbar) was performed in 17 patients with severe stable hypercapnic COPD. Two patients refused low-intensity NPPV and two patients dropped out while on low-intensity NPPV. Thirteen patients (mean forced expiratory volume in 1 s (FEV(1)) 0.76+/-0.29 l) completed the trial. High-intensity NPPV produced higher pneumotachographically-measured expiratory volumes, with a mean treatment effect of 96 ml (95% CI 23 to 169) (p=0.015). This resulted in a mean treatment effect on nocturnal arterial carbon dioxide tension (Paco(2)) of -9.2 mm Hg (95% CI -13.7 to -4.6) (p=0.001) in favour of high-intensity NPPV. Daily use of NPPV was increased in high-intensity NPPV compared with low-intensity NPPV, with a mean difference of 3.6 h/day (95% CI 0.6 to 6.7) (p=0.024). In addition, compared with baseline, only high-intensity NPPV resulted in significant improvements in exercise-related dyspnoea, daytime Paco(2), FEV(1), vital capacity and the Severe Respiratory Insufficiency Questionnaire Summary Score. High-intensity NPPV is better tolerated by patients with severe chronic hypercapnic COPD and has been shown to be superior to the conventional and widely-used form of low-intensity NPPV in controlling nocturnal hypoventilation. High-intensity NPPV therefore offers a new promising therapeutic option for these patients.
              Article 0 comments Cited 74 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Clin Respir J
                Journal ID (iso-abbrev): Eur Clin Respir J
                Journal ID (publisher-id): ZECR
                Journal ID (publisher-id): zecr20
                Title: European Clinical Respiratory Journal
                Publisher: Taylor & Francis
                ISSN (Electronic): 2001-8525
                Publication date Collection: 2019
                Publication date (Electronic): 23 July 2019
                Volume: 6
                Issue: 1
                Electronic Location Identifier: 1644893
                Affiliations
                [a ]Lillebaelt Hospital, University Hospital of Southern Denmark , Odense, Denmark
                [b ]Aarhus University Hospital, Aarhus Denmark , Aarhus, Denmark
                Author notes
                Article
                Publisher ID: 1644893
                DOI: 10.1080/20018525.2019.1644893
                PMC ID: 6691917
                SO-VID: b524f7ed-00a8-47f9-bfe6-27402cb0d9cc
                Copyright © © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 March 2019
                Date accepted : 10 July 2019
                Page count
                Figures: 5, Tables: 1, References: 14, Pages: 8
                Categories
                Subject: Review Article

                Keywords: copd,non-invasive ventilation,chronic hypercapnia,home mechanical ventilation,niv,chronic obstructive pulmonary disease
                Data availability:
                Keywords: copd, non-invasive ventilation, chronic hypercapnia, home mechanical ventilation, niv, chronic obstructive pulmonary disease

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