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

Abstract

Background: While there is no overall evidence for NIPPV in stable COPD, it may be beneficial for patients who remain hypercapnic after an episode of acute respiratory failure known to have a dismal prognosis.
Aims: The hypothesis of this study was that withdrawal of NIPPV causes clinical worsening.
Methods: We included 26 consecutive COPD patients (63±6 years, 58% male, FEV1 0.79±0.32 liters) who remained hypercapnic (paCO2 56±11 mmHg) after an episode of acute respiratory failure requiring mechanical ventilation. After 6 months (run in period) during which all patients received NIPPV they were randomized to either continue (ventilation group, n=13) or to stop NIPPV (withdrawal group, n=13). The end point was clinical worsening defined as escalation of mechanical ventilation (ICU admission or resumption of NIPPV in the withdrawal group due to dyspnoea or progressive hypercapnia). The follow up period was 12 months with control visits every 3 months.
Results: All patients were stable during the 6 month run in period. During follow up, the withdrawal group had a significantly higher probability of clinical worsening, as compared to the ventilation group (p=0.0018). Thus, after 12 months 77% and 15% of patients had experienced clinical worsening in the withdrawal group (3 ICU admissions, 4 resumptions of NIPPV due to severe dyspnoea, 3 due to progressive hypercapnia) and in the ventilation group (2 ICU admissions), respectively (p=0.0048).
Conclusion: Discontinuation of NIPPV causes clinical worsening in stable COPD patients who remain hypercapnic after an episode of acute respiratory failure requiring mechanical ventilation.

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Citations should be made in the following way:
G. C. Funk, M. Breyer, O. C. Burghuber, K. Kirchheiner, I. Schmidt, S. Hartl (Vienna, Austria). Nocturnal non-invasive positive pressure ventilation (NIPPV) in stable hypercapnic COPD patients – a randomized controlled trial. Eur Respir J 2008; 32: Suppl. 52, 360

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