High-pressure NIV for acute hypercapnic respiratory failure in COPD: improved survival in a retrospective cohort study
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High-pressure NIV for acute hypercapnic respiratory failure in COPD : improved survival in a retrospective cohort study. / Hedsund, Caroline; Nilsson, Philip Mørkeberg; Hoyer, Nils; Rasmussen, Daniel Bech; Holm, Claire Præst; Sonne, Tine Peick; Jensen, Jens Ulrik Stæhr; Wilcke, Jon Torgny.
In: BMJ Open Respiratory Research, Vol. 9, No. 1, e001260, 2022.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - High-pressure NIV for acute hypercapnic respiratory failure in COPD
T2 - improved survival in a retrospective cohort study
AU - Hedsund, Caroline
AU - Nilsson, Philip Mørkeberg
AU - Hoyer, Nils
AU - Rasmussen, Daniel Bech
AU - Holm, Claire Præst
AU - Sonne, Tine Peick
AU - Jensen, Jens Ulrik Stæhr
AU - Wilcke, Jon Torgny
N1 - Funding Information: This study was supported by the local research council at Herlev and Gentofte Hospital.
PY - 2022
Y1 - 2022
N2 - Introduction Updated treatment guidelines for acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) with non-invasive ventilation (NIV) in 2016 recommended a rapid increase in inspiratory positive airway pressure (IPAP) to 20 cm H 2 O with possible further increase for patients not responding. Previous guidelines from 2006 suggested a more conservative algorithm and maximum IPAP of 20 cm H 2 O. Aim To determine whether updated guidelines recommending higher IPAP during NIV were related with improved outcome in patients with COPD admitted with AHRF, compared with NIV with lower IPAP. Methods A retrospective cohort study comparing patients with COPD admitted with AHRF requiring NIV in 2012-2013 and 2017-2018. Results 101 patients were included in the 2012-2013 cohort with low IPAP regime and 80 patients in the 2017-2018 cohort with high IPAP regime. Baseline characteristics, including age, forced expiratory volume in 1 s (FEV 1), pH and PaCO 2 at initiation of NIV, were comparable. Median IPAP in the 2012-2013 cohort was 12 cm H 2 O (IQR 10-14) and 20 cm H 2 O (IQR 18-24) in the 2017-2018 cohort (p<0.001). In-hospital mortality was 40.5% in the 2012-2013 cohort and 13.8% in the 2017-2018 cohort (p<0.001). The 30-days and 1-year mortality were significantly lower in the 2017-2018 cohort. With a Cox model 1 year survival analysis, adjusted for age, sex, FEV 1 and pH at NIV initiation, the HR was 0.45 (95% CI 0.27 to 0.74, p=0.002). Conclusion Short-term and long-term survival rates were substantially higher in the cohort treated with higher IPAP. Our data support the current strategy of rapid increase and higher pressure.
AB - Introduction Updated treatment guidelines for acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) with non-invasive ventilation (NIV) in 2016 recommended a rapid increase in inspiratory positive airway pressure (IPAP) to 20 cm H 2 O with possible further increase for patients not responding. Previous guidelines from 2006 suggested a more conservative algorithm and maximum IPAP of 20 cm H 2 O. Aim To determine whether updated guidelines recommending higher IPAP during NIV were related with improved outcome in patients with COPD admitted with AHRF, compared with NIV with lower IPAP. Methods A retrospective cohort study comparing patients with COPD admitted with AHRF requiring NIV in 2012-2013 and 2017-2018. Results 101 patients were included in the 2012-2013 cohort with low IPAP regime and 80 patients in the 2017-2018 cohort with high IPAP regime. Baseline characteristics, including age, forced expiratory volume in 1 s (FEV 1), pH and PaCO 2 at initiation of NIV, were comparable. Median IPAP in the 2012-2013 cohort was 12 cm H 2 O (IQR 10-14) and 20 cm H 2 O (IQR 18-24) in the 2017-2018 cohort (p<0.001). In-hospital mortality was 40.5% in the 2012-2013 cohort and 13.8% in the 2017-2018 cohort (p<0.001). The 30-days and 1-year mortality were significantly lower in the 2017-2018 cohort. With a Cox model 1 year survival analysis, adjusted for age, sex, FEV 1 and pH at NIV initiation, the HR was 0.45 (95% CI 0.27 to 0.74, p=0.002). Conclusion Short-term and long-term survival rates were substantially higher in the cohort treated with higher IPAP. Our data support the current strategy of rapid increase and higher pressure.
KW - COPD Exacerbations
KW - Non invasive ventilation
U2 - 10.1136/bmjresp-2022-001260
DO - 10.1136/bmjresp-2022-001260
M3 - Journal article
C2 - 35728841
AN - SCOPUS:85132247660
VL - 9
JO - B M J Open Respiratory Research
JF - B M J Open Respiratory Research
SN - 2052-4439
IS - 1
M1 - e001260
ER -
ID: 327685418