Source: Annual Congress 2008 - Progress and a new era for noninvasive mechanical ventilation
Disease area: Respiratory critical care

Abstract

Introduction
COPD patients who survive an episode of acute hypercapnic respiratory failure (AHRF) after non-invasive ventilation (NIV) are at high risk of recurrent AHRF.
Aims and objectives
We hypothesize that continuation of NIV at home would prevent recurrent AHRF in these patients.
Methods
This is a prospective randomized single-blind study, comparing continuation of home NIV (BiPAP SynchronyÔ, Respironics INC., Murrysville, PA, USA) vs. sham ventilation in COPD patients who survived AHRF after acute NIV. Patients with significant OSA, non-COPD causes of AHRF, severe comorbidity and adverse psycho-social circumstances are excluded. The primary end-point is time-to-recurrent AHRF.
Results
At the time of writing, 85 patients met inclusion criteria, and 42 consented to the study with 38 males and 4 females at a mean age of 70.4 ± 7.8 years and mean FEV₁ of 29.9 ± 9.3 % predicted. Mean pH on admission was 7.27 ± 0.06 and mean PaCO₂ was 77.9 ± 24.0 mmHg. Twenty patients were randomised to home NIV group with mean IPAP of 14.9 ± 1.1 cmH₂O and EPAP of 5.0 ± 0.0 cmH₂O. Twenty-two patients received sham home ventilation (CPAP 5 cmH₂O). At 120 days, 81.3% of the home NIV group vs. 33.0% of the sham group were free of recurrent AHRF.

Conclusions
In COPD patients with AHRF treated by acute NIV, continuation with home NIV is associated with a trend to better outcome vs. sham ventilation.

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Citations should be made in the following way:
C. M. Chu, A. Cheung, V. Chan, J. Liong, W. S. Leung, A. Lin (Kowloon, Hong Kong). A randomised trial of home non-invasive ventilation vs. sham ventilation in survivors of acute hypercapnic respiratory failure in COPD. Eur Respir J 2008; 32: Suppl. 52, 365

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