Long-term outcomes after acute hypercapnic COPD exacerbation : First-ever episode of non-invasive ventilation.

Andreas S Fazekas,Georg-Christian Funk,Marie-Kathrin Breyer,Matthias Urban,Ruxandra C Kriz,Otto-Chris Burghuber,Robab Breyer-Kohansal,Mei Aboulghaith,Sylvia Hartl

doi:10.1007/s00508-018-1364-6

Abstract

SummaryBackgroundNon-invasive ventilation (NIV) is used to treat acute hypercapnic respiratory failure (AHRF) in patients with chronic obstructive pulmonary disease (COPD); however, long-term outcomes following discharge are largely unknown. This study aimed to characterize long-term outcomes and identify associated markers in patients with COPD after surviving the first episode of HRF requiring NIV.MethodsThis study retrospectively analyzed 122 patients, mean age 62 ± 8 years, 52% female and forced expiratory volume in 1 s (FEV1) predicted 30 ± 13%, admitted with an acute hypercapnic exacerbation of COPD and receiving a first-ever NIV treatment between 2000 and 2012.ResultsA total of 40% of the patients required hospital readmission due to respiratory reasons within 1 year. Persistent hypercapnia leading to the prescription of domiciliary NIV, older age and lower body mass index (BMI) were risk factors for readmission due to respiratory reasons. Survival rates were 79% and 63% at 1 and 2 years after discharge, respectively. A shorter time to readmission and recurrent hypercapnic failure, lower BMI and acidemia on the first admission, as well as hypercapnia at hospital discharge were correlated with a decreased long-term survival.ConclusionPatients with COPD surviving their first episode of AHRF requiring NIV are at high risk for readmission and death. Severe respiratory acidosis, chronic respiratory failure and a lower BMI imply shorter long-term survival.Electronic supplementary materialThe online version of this article (10.1007/s00508-018-1364-6) contains supplementary material, which is available to authorized users.

Highlights

Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide, resulting in an enormous burden on patients and on healthcare systems [1]
Patients with COPD surviving their first episode of acute hypercapnic respiratory failure (AHRF) requiring non-invasive ventilation (NIV) are at high risk for readmission and death
● Patients with COPD surviving their first episode of hypercapnic respiratory failure (AHRF) requiring noninvasive ventilation (NIV) are at high risk for readmission and death

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide, resulting in an enormous burden on patients and on healthcare systems [1]. Severe exacerbations with acute hypercapnic respiratory failure (AHRF) may warrant admission to the intensive care unit (ICU) for non-invasive ventilation (NIV) [10]. Patients surviving such a respiratory crisis are at high risk for readmission and death [5, 11]. The long-term outcome in COPD patients surviving a hypercapnic exacerbation treated with NIV on the intensive care unit (ICU) has not been given sufficient attention to date. The aim of this study was to characterize the long-term outcome after hypercapnic COPD exacerbations requiring NIV in the ICU and to investigate associated markers

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