Survival of Hypercapnic Patients with COPD and Obesity Hypoventilation Syndrome Treated with High Intensity Non Invasive Ventilation in the Daily Routine Care.

Stefanie Pohl,Wolfgang Schütte,Christine Lautenschläger,Thomas Blankenburg,Anett Bramer,Frank Kalbitz,Christin Benthin

doi:10.2174/1874306401711010031

Abstract

Background:Home ventilation is an effective treatment option for obesity hypoventilation syndrome (OHS). This therapy is still controversial for stable chronic obstructive pulmonary disease (COPD). A recent study showed reduced mortality for COPD patients receiving home ventilation with high inflation pressures and back-up respiratory rates [so called High Intensity non-invasive ventilation (NIV)].Objective:The purpose of this study is whether High Intensity NIV applied in the routine care of COPD and OHS patients can lead to CO2 reduction and survival data comparable to data from controlled studies.Method:In this prospective non interventional study fifty-one patients with COPD (FEV1 0.95l, corr. 32.8%) and 34 patients with OHS (VC 1.74l, corr. 50.7%) with chronic hypercapnic respiratory failure, who were treated with NIV were followed up for four years.Results:Elevated CO2 values before NIV in COPD patients (8.6kPa), and in OHS patients (8.3kPa), could be lowered significantly to the upper normal range (COPD: 5.9kPa; OHS: 5.85kPa). The one-, two-, and three-year survival rates for COPD patients were 83%, 73%, and 55%, respectively. The one-, two-, and three-year survival rates for OHS patients were 85%, 72%, and 68%, respectively.Conclusion:High intensity NIV within routine care is effective in reducing blood CO2 levels in COPD- and in OHS- related chronic respiratory insufficiency. The survival rates obtained here are comparable to data from controlled clinical trials on COPD.

Highlights

Chronic respiratory failure, in severe chronic obstructive pulmonary disease (COPD), leads to a deterioration of the quality of life and a significant worsening of prognosis [1]
High intensity non-invasive ventilation (NIV) within routine care is effective in reducing blood CO2 levels in COPD- and in obesity hypoventilation syndrome (OHS)- related chronic respiratory insufficiency
Pulmonary function analysis in COPD patients showed a severe degree of obstructive respiratory disorder, as well as, severe distension of the lung

Summary

Introduction

In severe COPD, leads to a deterioration of the quality of life and a significant worsening of prognosis [1]. Compared with other diseases, such as obesity hypoventilation syndrome (OHS), the clinical and prognostic effects of non-invasive ventilation (NIV), in chronic respiratory failure due to COPD, are not always demonstrable [3, 4]. In studies showing benefits to prognosis and the quality of life, or a reduced hospitalisation rate in COPD, the patients were predominantly severely hypercapnic and the treatment was carried out with high pressures and high ventilation rates (so called “High Intensity NIV”) [5 - 10]. Home ventilation is an effective treatment option for obesity hypoventilation syndrome (OHS) This therapy is still controversial for stable chronic obstructive pulmonary disease (COPD). A recent study showed reduced mortality for COPD patients receiving home ventilation with high inflation pressures and back-up respiratory rates [so called High Intensity non-invasive ventilation (NIV)]

Results

Discussion

Conclusion