High-pressure NIV for acute hypercapnic respiratory failure in COPD: improved survival in a retrospective cohort study
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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.
Original language | English |
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Article number | e001260 |
Journal | BMJ Open Respiratory Research |
Volume | 9 |
Issue number | 1 |
Number of pages | 7 |
ISSN | 2052-4439 |
DOIs | |
Publication status | Published - 2022 |
Bibliographical note
Funding Information:
This study was supported by the local research council at Herlev and Gentofte Hospital.
- COPD Exacerbations, Non invasive ventilation
Research areas
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