Authors: Budweiser, S.; Hitzl, A. P.; Jörres, R. A.¹; Heinemann, F.²; Arzt, M.³; Schroll, S.³; Pfeifer, M.

Source: International Journal of Clinical Practice, Volume 61, Number 9, September 2007 , pp. 1516-1522(7)

Publisher: Wiley-Blackwell

Abstract:

Summary Aims: 

The long-term benefit from noninvasive ventilation (NIV) in chronic hypercapnic chronic obstructive pulmonary disease (COPD) remains uncertain. Methods: 

Within a prospective observational design, we compared the long-term survival of 140 patients with severe persistent hypercapnic COPD (FEV₁ 28.7 ± 8.7% predicted; PaCO₂ 60.1 ± 9.2 mmHg) with (n = 99) or without (n = 41) NIV. End-point was all-cause mortality, determined up to 4 years by Kaplan-Meier analysis. Additionally, Cox's proportional hazards regression and stratification by risk factors was performed. Patients were characterised by anthropometric and functional parameters, comorbidities and medical therapy. Results: 

Adherence in patients with NIV was high (88.9%), daily ventilator use being 6.4 ± 2.6 h/day and inspiratory pressures 21.0 ± 4.0 cmH₂O. One- and 2-year survival rates were 87.7% and 71.8%, respectively, in patients with NIV vs. 56.7% and 42.0% in patients without NIV. Survival rates were significantly higher in patients with NIV compared to those without this therapy (p = 0.001; hazard ratio 0.380; 95% confidence interval 0.138-0.606). The difference between groups was still significant after adjustment for differences in baseline characteristics. Moreover, stratification by risk factors revealed beneficial effects, particularly in patients with high base excess (BE; > 8.9 mmol/l), low pH (< 7.41), FEV₁ (< 27.5%) haemoglobin (< 13.8 g/dl) or large hyperinflation (residual volume-to-total lung capacity > 189% predicted) upon inclusion (p < 0.05 each). Conclusion: 

In patients with severe chronic hypercapnic COPD receiving NIV at high inspiratory pressure levels and showing high adherence to this therapy, long-term survival was significantly higher than in non-ventilated patients. Patients displaying more severe disease according to known risk factors seemed to benefit most from long-term NIV.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1742-1241.2007.01427.x

Affiliations: 1: Institute and Outpatient Clinic for Occupational and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany 2: Center for Pneumology, Hospital Donaustauf, Donaustauf, Germany 3: Department of Internal Medicine II, University of Regensburg, Regensburg, Germany

Publication date: 2007-09-01

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