Home NIV after an acute exacerbation of COPD: criteria and outcomes

Abstract

<b>Introduction:</b> Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have high mortality rates. Criteria for home non-invasive ventilation (NIV) after AECOPD with hypercapnic respiratory failure (HRF) are not well defined. <b>Objectives:</b> Characterize patients admitted with an inaugural AECOPD requiring NIV and identify criteria for home NIV as well as compare outcomes between those discharged with or without NIV. <b>Methods:</b> A retrospective analysis of patients with the first AECOPD submitted to NIV in 2016-18. Clinical data, FEV1, arterial blood gas, length of stay (LOS), 3 month-readmission, 1 year-mortality and home NIV initiation were analyzed. <b>Results:</b> 66 patients (61% males), with a mean age 76±10 years were included, mainly smokers/former-smokers (65%). Average FEV1 was 48±22%. After hospital discharge, 44% of the patients maintained NIV at home. These patients had worse FEV1, more exacerbations in the previous year and a longer LOS. They were less readmitted at 3 months versus non-home NIV patients. One-year mortality was 36% with no differences between the two groups. In patients discharged without NIV, home NIV was implemented later in 16 patients (43%). Predictive factors were worse lung function (FEV1 36±14%vs58±22%; p&lt;0.01) and hypercapnia at hospital discharge. <b>Conclusion:</b> In this cohort of patients, exacerbation phenotype, worse lung function and hypercapnia at discharge increased the risk of needing home NIV. Thus, it is important to adequately identify which patients will benefit from NIV after AECOPD in order to decrease further exacerbations, which associates with worse prognosis and quality of life.