Hypercapnic Respiratory Failure Research Articles

Severe respiratory failure secondary to unilateral phrenic nerve injury: A case report

AbstractPatients with unilateral phrenic nerve paralysis are usually asymptomatic at rest. We present a 77‐year‐old woman with a chest wall osteoarthropathy associated with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome that developed severe hypercapnic respiratory failure following cryoballoon ablation for the management of atrial fibrillation. Her right phrenic nerve injury (PNI) was confirmed by chest radiography, phrenic nerve conduction studies, and diaphragmatic ultrasonography. We conclude that unilateral PNI during ablation invalidated the diaphragmatic compensation for pre‐existing reduced thoracic expansion, resulted in severe hypoventilation. Clinicians should be careful of the fact even unilateral PNI could cause catastrophic respiratory failure in patients with restricted thoracic expansion.

Long-term outcomes in patients with COPD treated with non-invasive ventilation for acute hypercapnic respiratory failure.

Chronic Obstructive Lung Disease (COPD) remains a major cause of morbidity and mortality across the world. We evaluated survival over 9years in a cohort of patients with COPD requiring acute inpatient non-invasive ventilation (NIV). We analyzed prognostic indices to evaluate if they were associated with mortality. We performed a retrospective chart review of all patients who were admitted to St. James's Hospital respiratory ward with COPD and acute hypercapnic respiratory failure who required NIV over a 12-month period and followed their outcomes over 9years. We investigated the association between survival and potential prognostic variables using univariate analysis and multivariate Cox proportional hazards model. We evaluated the association between survival and the following parameters: age, gender, multiple admissions requiring NIV (> 1 admission in within 12months of index presentation), home NIV use preadmission, initial arterial blood gas pH, days spent on NIV, serum albumin and serum albumin to serum CRP ratio at admission. Ninety-nine patients with COPD and acute hypercapnic respiratory failure were identified over a 12-month period from January to December 2011. Survival at 1, 2, 5 and 9years was 65% (n = 64), 42% (n = 42), 25% (n = 25) and 21% (n = 21), respectively. Increasing age (p value < 0.001) and a lower serum albumin (p value < 0.005) were associated with a higher mortality. There was a trend towards improved survival in the group who were treated with home NIV prior to admission compared to no NIV therapy at home but this did not reach statistical significance (Fig.3, p value = 0.088). This study highlights the long-term mortality in patients with COPD admitted with hypercapnic respiratory failure requiring NIV and correlates with prior studies. Increasing age and lower serum albumin were associated with increased mortality.Home NIV may have a protective long-term survival benefit in patients with COPD who have been admitted for acute NIV.

Intercostal Muscle Function During Noninvasive Ventilation and Acute Hypercapnic Respiratory Failure

Intercostal Muscle Function During Noninvasive Ventilation and Acute Hypercapnic Respiratory Failure

Home respiratory strategies in COPD patients with chronic hypercapnic respiratory failure: a systematic review and network meta-analysis.

Background: Home non-invasive positive pressure ventilation (NPPV) may improve chronic hypercarbia in COPD and patient important outcomes. The efficacy of home high flow nasal cannula (HFNC) as an alternative is unclear.Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, SCOPUS, and Clinicaltrials.gov for randomized trials of patients from inception to March 31st and updated the search on July 14, 2023. We performed a frequentist network meta-analysis and assessed the certainty of the evidence using the GRADE approach. We analyzed randomized trials (RCTs) comparing NPPV, HFNC, or standard care in adult COPD patients with chronic hypercapnic respiratory failure. Outcomes included mortality, COPD exacerbations, hospitalizations, and quality of life (SGRQ).Results: We analyzed twenty-four RCTs (1850 patients). We found that NPPV may reduce death risk compared to standard care (relative risk [RR] 0.82 [95% CI 0.66 to 1.00]) and probably reduces acute exacerbations (RR 0.71 [95% CI 0.58 to 0.87]). HFNC probably reduces acute exacerbations compared to standard care (RR 0.77 [0.68 to 0.88]) but its effect on mortality is uncertain (RR 1.20 [95% CI 0.63 to 2.28]). HFNC probably improves SGRQ scores (mean difference [MD] -7.01 [95% CI -12.27 to -1.77]) and may reduce hospitalizations (RR 0.87 [0.69 to 1.09]) compared to standard care. No significant difference was observed between HFNC and NPPV in reducing exacerbations.Conclusion: Both NPPV and HFNC reduce exacerbation risks in COPD patients compared to standard care. HFNC may offer advantages in improving quality of life.

High velocity nasal insufflation versus non-invasive ventilation in acute respiratory failure: a comparative study

Background In order to treat respiratory failure, thermo-humidified nasal high flow oxygen (NHFO) therapy is being used more and more. In several clinical scenarios, NHFO has recently gained popularity as alternative noninvasive respiratory ventilation. Aim The aim is to assess the role of high velocity nasal insufflation (HVNI) versus noninvasive ventilation (NIV) in acute respiratory failure. Patients and methods This is a prospective randomized clinical study conducted on 60 patients admitted to the Chest Department at Menoufia University Hospital with acute respiratory failure. Patients were randomized to receive either noninvasive positive pressure ventilation using an oronasal mask or high-velocity nasal insufflation (initial flow was at 30-40 l/min; temperature was adjusted to 37°C; fraction of inspired oxygen 1.0) with clinical monitoring and arterial blood gas (ABG) monitoring after 2, 6, 12, and 24 h. Results The therapeutic impact of both, HVNI and NIV, on pressure of arterial carbon dioxide (PaCO2), hydrogen ion concentration, arterial oxygen saturation and pressure of arterial oxygen (PaO2) over time was almost similar. There was an improvement in dyspnea and a decrease in respiratory rate over time when compared with baseline results in both groups. There was no statistical difference between both groups. The failure rate in type I respiratory failure (RF) was 33.3% in the HVNI group and 28.6% in the NIV group (P-value 0.7). The failure rate in type II RF was 41.7% in the HVNI group and 25% in the NIV group (P-value 0.3). HVNI was more comfortable for patients and provided better communication and oral intake. Conclusion This study demonstrates that the HVNI was comparable to the NIV in the management of hypoxemic respiratory failure and could be used as a noninvasive method of ventilation alternative to the BiPAP in hypercapnic RF, with more comfortability and better communication in the HVNI group.

Veno-Venous Extracorporeal Membrane Oxygenation in Pregnancy: A Literature Review

Abstract: &#x0D; Extracorporeal membrane oxygenation (ECMO) is a specialized technique providing temporary support for failed cardiac and respiratory functions. While commonly used in neonates and children, its application in obstetric patients is gaining traction. In hypoxemic and hypercapnic respiratory failure with intact cardiac function, Veno-Venous ECMO (VV-ECMO) offers artificial oxygenation and decarboxylation. This comprehensive article discusses VV-ECMO in obstetrics, covering prevalence, maternal and neonatal outcomes, mechanisms, protocols, access sites, indications, contraindications, anticoagulation, complications, and considerations.&#x0D; The VV-ECMO procedure involves redirecting blood from the heart or major veins through an artificial lung and back to the heart, improving oxygenation, respiratory mechanics, and cardiac function while reducing lung injury risk. Cannulation methods range from double-lumen to bi-femoral, depending on patient needs. Prevalence of VV-ECMO in pregnancy is 8.9%. Outcomes vary based on factors like medical condition and gestational age. Survival rates range from 63% to 76% for pregnant patients and 70% to 86% for infants. Common indications encompass severe H1N1 influenza, pre-eclampsia, and viral infections.&#x0D; Contraindications involve refusal, end-stage malignancy, and severe neurologic injury. Anticoagulation, crucial for preventing clotting in the ECMO circuit, primarily employs unfractionated heparin. Complications include bleeding, thrombosis, and infections. In pregnancy, similar indications exist, with VV-ECMO typically proving safe and effective for both maternal and fetal survival.&#x0D;

Internet of things-based management versus standard management of home noninvasive ventilation in COPD patients with hypercapnic chronic respiratory failure: a multicentre randomized controlled non-inferiority trial

Effective monitoring and management are crucial during long-term home noninvasive positive pressure ventilation (NPPV) in patients with hypercapnic chronic obstructive pulmonary disease (COPD). This study investigated the benefit of Internet of Things (IOT)-based management of home NPPV. This multicenter, prospective, parallel-group, randomized controlled non-inferiority trial enrolled patients requiring long-term home NPPV for hypercapnic COPD. Patients were randomly assigned (1:1), via a computer-generated randomization sequence, to standard home management or IOT management based on telemonitoring of clinical and ventilator parameters over 12 months. The intervention was unblinded, but outcome assessment was blinded to management assignment. The primary outcome was the between-group comparison of the change in health-related quality of life, based on severe respiratory insufficiency questionnaire scores with a non-inferiority margin of-5. This study is registered with Chinese Clinical Trials Registry (No. ChiCTR1800019536). Overall, 148 patients (age: 72.7±6.8 years; male: 85.8%; forced expiratory volume in 1s: 0.7±0.3L; PaCO2: 66.4±12.0mmHg), recruited from 11 Chinese hospitals between January 24, 2019, and June 28, 2021, were randomly allocated to the intervention group (n=73) or the control group (n=75). At 12 months, the mean severe respiratory insufficiency questionnaire score was 56.5 in the intervention group and 50.0 in the control group (adjusted between-group difference: 6.26 [95% CI, 3.71-8.80]; P<0.001), satisfying the hypothesis of non-inferiority. The 12-month risk of readmission was 34.3% in intervention group compared with 56.0% in the control group, adjusted hazard ratio of 0.56 (95% CI, 0.34-0.92; P=0.023). No severe adverse events were reported. Among stable patients with hypercapnic COPD, using IOT-based management for home NPPV improved health-related quality of life and prolonged the time to readmission. Air Liquide Healthcare (Beijing) Co., Ltd.

Hypercapnia is not excluded by normoxia in neuromuscular disease patients: implications for oximetry

BackgroundPulse oximetry is widely used in the assessment of chronic respiratory failure (CHRF) in neuromuscular disease (NMD) patients. CHRF is the major cause of morbidity and mortality, necessitating early diagnosis and intervention. Guidelines suggest an arterial blood gas (ABG) is indicated if oxygen saturations (SpO2)≤94% in the absence of lung disease. However, hypercapnia with normoxia (SpO2≥95%) has been observed on ABGs of patients with NMD, in particular those with motor neurone disease (MND).MethodsA single-centre retrospective audit of room-air ABGs in stable hypercapnic chronic respiratory failure (CHRF) patients from 1990–2020 was performed. Patients with parenchymal lung disease were excluded. Patients were grouped into three main categories: non-NMD, other-NMD and MND.FindingsTwo-hundred and ninety-seven ABGs with hypercapnia from 180 patients with extrinsic restrictive lung disease were analysed. No patients with non-NMD, 54% of other-NMD and 36% of MND patients demonstrated hypercapnia with normoxia (χ261.33; p&lt;0.001). The potential mechanism is proposed to be a difference in calculated respiratory quotient (RQ). If the A-a gradient is assumed to be normal, the calculated RQ was significantly higher in MND patients and other-NMD patients compared with non-NMD patients (estimated-marginal-mean 0.99 [95%CI 0.94–1.03]; 0·86 [95%CI 0.76–0.96]; 0·73 [95%CI 0.63—0.83] respectively; p&lt;0.001) by mixed-model analysis.InterpretationHypercapnia is not excluded with normal oximetry in NMD patients and may be due to an elevated RQ. This has implications in the diagnosis and monitoring of respiratory insufficiency in NMD patients with oximetry alone.FundingDr Emma Gray received an NHMRC Postgraduate Scholarship.

Inspiratory Muscle Dysfunction Mediates and Predicts a Disease Continuum of Hypercapnic Failure in Chronic Obstructive Pulmonary Disease.

Advanced chronic obstructive pulmonary disease (COPD) is associated with chronic hypercapnic failure. The present work aimed to comprehensively investigate inspiratory muscle function as a potential key determinant of hypercapnic respiratory failure in patients with COPD. Prospective patient recruitment encompassed 61 stable subjects with COPD across different stages of respiratory failure, ranging from normocapnia to isolated nighttime hypercapnia and daytime hypercapnia. Arterialized blood gas analyses and overnight transcutaneous capnometry were used for patient stratification. Assessment of respiratory muscle function encompassed body plethysmography, maximum inspiratory pressure (MIP), diaphragm ultrasound, and transdiaphragmatic pressure recordings following cervical magnetic stimulation of the phrenic nerves (twPdi) and a maximum sniff manoeuvre (Sniff Pdi). Twenty patients showed no hypercapnia, 10 had isolated nocturnal hypercapnia, and 31 had daytime hypercapnia. Body plethysmography clearly distinguished patients with and without hypercapnia but did not discriminate patients with isolated nocturnal hypercapnia from those with daytime hypercapnia. In contrast to ultrasound parameters and transdiaphragmatic pressures, only MIP reflected the extent of hypercapnia across all three stages. MIP values below -48 cmH2O predicted nocturnal hypercapnia (area under the curve = 0.733, p = 0.052). In COPD, inspiratory muscle dysfunction contributes to progressive hypercapnic failure. In contrast to invasive tests of diaphragm strength only MIP fully reflects the pathophysiological continuum of hypercapnic failure and predicts isolated nocturnal hypercapnia.

Extracorporeal Carbon Dioxide Removal to De-escalate Venovenous Extracorporeal Membrane Oxygenation in Severe COVID-19 Acute Respiratory Distress Syndrome

In a subset of patients with COVID-19 acute respiratory distress syndrome (ARDS), there is a need for extracorporeal membrane oxygenation (ECMO) for pulmonary support. The primary extracorporeal support tool for severe COVID-19 ARDS is venovenous (VV) ECMO; however, after hypoxemic respiratory failure resolves, many patients experience refractory residual hypercarbic respiratory failure. Extracorporeal carbon dioxide removal (ECCO2R) for isolated hypercarbic type II respiratory failure can be used in select cases to deescalate patients from VV ECMO while the lung recovers the ability to exchange CO2. The objective of this study was to describe the authors' experience in using ECCO2R as a bridge from VV ECMO. Hemolung Respiratory Assist System (RAS) is a commercially available (ECCO2R) device, and the United States Food and Drug Administration accelerated its use under its Emergency Use Authorization for the treatment of refractory hypercarbic respiratory failure in COVID-19-induced ARDS. This created an environment in which selected and targeted mechanical circulatory support therapy for refractory hypercarbic respiratory failure could be addressed. This retrospective study describes the application of Hemolung RAS as a VV ECMO deescalation platform to treat refractory hypercarbic respiratory failure after the resolution of hypoxemic COVID-19 ARDS. A quaternary-care academic medical center, single institution. Patients with refractory hypercarbic respiratory failure after COVID-19 ARDS who were previously supported with VV ECMO. Twenty-one patients were placed on ECCO2R after VV ECMO for COVID-19 ARDS. Seventeen patients successfully were transitioned to ECCO2R and then decannulated; 3 patients required reescalation to VV ECMO secondary to hypercapnic respiratory failure, and 1 patient died while on ECCO2R. Five (23.8%) of the 21 patients were transitioned off of VV ECMO to ECCO2R, with a compliance of <20 (mL/cmH2O). Of these patients, 3 with low compliance were reescalated to VV ECMO. Extracorporeal carbon dioxide removal can be used to continue supportive methods for patients with refractory type 2 hypercarbic respiratory failure after COVID-19 ARDS for patients previously on VV ECMO. Patients with low compliance have a higher rate of reescalation to VV ECMO.

High-Flow Nasal Cannula Oxygen Therapy in the Management of Respiratory Failure: A Review.

High-flow nasal cannula (HFNC) oxygen therapy is gaining traction globally as a treatment for respiratory failure. There are several physiological benefits, and there is a growing body of evidence showing improved quality of life and patient comfort with HFNC, both in acute and home settings. Due to the increased burden of long-term respiratory conditions such as chronic obstructive pulmonary disease (COPD) on healthcare systems worldwide, the role of ward-based and post-discharge interventions in the prevention of hospital readmissions is an area of increasing interest.In this narrative review, we outline the physiological effects of HFNCand assess its applications in both the hospital andhome settings for acute and chronic respiratory failure. We also consider the evidence of non-invasive ventilation (NIV) versus HFNC in the hospital setting and the application of HFNC at home in stable hypercapnic respiratory failure to improve the quality of life and prevent readmissions. We also look at applications of HFNC in specific circumstances, such as the perioperative period, emergency department, and acute (mainly critical care) setting including in immunocompromised patients and palliative care.

An atypical airway cast.

A 60-year-old man intubated for airway protection after smoke inhalation was found to have decompensated hypercapnic respiratory failure. Fiberoptic bronchoscopy revealed obstructive airway slough and pseudomembrane, a manifestation of severe inhalation injury. Veno-venous extracorporeal membrane oxygenation was established for stabilization. The airway casts were removed successfully with periprocedural veno-venous extracorporeal membrane oxygenation support.

Protracted respiratory failure in a case of global spinal syringomyelia and Chiari malformation following administration of diazepam: illustrative case.

Syringomyelia is defined as dilation of the spinal cord's central canal and is often precipitated by skull base herniation disorders. Although respiratory failure (RF) can be associated with skull base abnormalities due to brainstem compression, most cases occur in pediatric patients and quickly resolve. The authors report the case of an adult patient with global spinal syringomyelia and Chiari malformation who developed refractory RF after routine administration of diazepam. A 31-year-old female presented with malnutrition, a 1-month history of right-sided weakness, and normal respiratory dynamics. After administration of diazepam prior to magnetic resonance imaging (MRI), she suddenly developed hypercapnic RF followed MRI and required intubation. MRI disclosed a Chiari malformation type I and syrinx extending from C1 to the conus medullaris. After decompressive surgery, her respiratory function progressively returned to baseline status, although 22 months after initial benzodiazepine administration, the patient continues to require nocturnal ventilation. Administration of central nervous system depressants should be closely monitored in patients with extensive syrinx formation given the potential to exacerbate diminished central respiratory drive. Early identification of syrinx in the context of Chiari malformation and hemiplegia should prompt clinical suspicion of underlying respiratory compromise and early involvement of intensive care consultants.

Comments on "Comparison of immediate withdrawal and stepwise reduction in duration of non-invasive ventilation in chronic obstructive pulmonary disease patients presenting with acute hypercapnic respiratory failure"

Dear Editor, The recent study published by Purohit et al. provides new evidence on the safety of immediate withdrawal of non-invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients admitted with acute hypercapnic respiratory failure (AHRF) after recovery...

30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital.

Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.

High-intensity non-invasive ventilation during exercise-training versus without in people with very severe COPD and chronic hypercapnic respiratory failure: a randomised controlled trial

BackgroundPeople with very severe chronic obstructive pulmonary disease (COPD) using nocturnal non-invasive ventilation (NIV) for chronic hypercapnic respiratory failure (CHRF) experience reduced exercise capacity and severe dyspnoea during exercise training...

Characteristics of Patients with Asthma Attack Followed in the Intensive Care Unit

Objective: Asthma attack is a critical reason for morbidity and mortality if not treated effectively at the right time. Data about the efficiency of noninvasive and invasive mechanical ventilation (NIV, IMV) in respiratory failure due to asthma attacks are scant. The aim of this study was to investigate the relationship between asthma-related factors, medical and NIV/IMV treatments received in the Intensive Care Unit (ICU), and the mortality rates and length of hospital stay, in asthma attacks.&#x0D; Methods: The characteristics of patients with severe asthma treated in Hacettepe University Medical ICU for a ten-year period were analyzed from patient records retrospectively. The association between age, sex, comorbidities, asthma duration, treatment, adherence to the treatment, the effectiveness of NIV/IMV treatment if performed, and asthma attack severity, length of hospital stay, and mortality were investigated.&#x0D; Results: A total of 22 patients were included in this study. In addition to medical treatment, eight (36.6%) patients received NIV, five (22.7%) received invasive mechanical ventilation (IMV), and five (22.7%) patients had both. Four (18.1%) patients died in the ICU. There was no significant relationship between these parameters and length of hospital stay and mortality. The relationship between baseline PaCO2, pH, and HCO3 and the difference of PaCO2, pH, and HCO3¯ changes were significant, indicating the correct and effective use of NIV/IMV.&#x0D; Conclusion: NIV applications, which have been proven to be effective in hypercapnic respiratory failure, were also found to be effective in hypoxemic respiratory failure due to asthma attacks. The absence of a relationship between the investigated parameters and mortality revealed that the reasons for the mortality might be infections or comorbidities, not the respiratory tract.

O029 Clinical features and outcomes of patients referred to a Respiratory Failure service

Abstract Non-invasive ventilation (NIV) improves quality of life and mortality in patients with hypercapnic respiratory failure. We reviewed the last decade of long-term home NIV provision in a single centre via an observational retrospective study. Data were prospectively collected in a database. Anthropometric and demographic data were expressed as mean±SD. Indications for chronic home NIV were categorised into: neuromuscular diseases (NMD) [including motor neuron disease (MND)]; obstructive sleep apnoea/obesity hypoventilation (OSA/OHS); pulmonary disease; and others. Linear regression analysis was performed for the annual incidence by indication, and multivariate Cox regression performed compares MND mortality with other causes. 541 new patients (Age 60.8 ±17.1 years; 273 Female; BMI 33.4±13.9 kg/m2 (n=380)) were commenced on NIV between 2012-2022. Patient numbers increased by 2.3 (0.4-4.1) per year (slope, (95% confidence intervals); p&amp;lt;0.02). Indications for treatment included: 52% NMD (29% MND); 19% OSA/OHS; 19% pulmonary disease; and 10 % other causes. Average referral age, BMI and gender composition were stable over the time period. There was an increase in patients with pulmonary disease commenced on NIV of 0.6 (0.7-3.5)% per year (p&amp;lt;0.008), other indications for treatment were unchanged. 31.4% patients died (16.8% MND). Multivariate Cox regression analysis showed that a diagnosis of MND was associated with an increased likelihood of death (HR 11.42, p&amp;lt;0.0001). In the last decade, there’s been a gradual increase in patient numbers treated with chronic home NIV, with an increasing percentage of patients with pulmonary disease commenced on treatment. Mortality in MND patients on NIV is higher compared with other indications.

O056 Is Obstruction Obstructing Survival? Long-term Mortality in Patients with Chronic Obstructive Pulmonary Disease (COPD) requiring Acute Non-invasive Ventilation (NIV) with and without Obstructive sleep apnoea (OSA).

Abstract Introduction COPD/OSA overlap syndrome (OVS) is associated with poor outcomes in studies conducted in ambulatory settings. However, little is known about the prognosis of patients hospitalised with acute hypercapnic respiratory failure (ARF) requiring NIV. The aim of this study was to compare the long-term prognosis of OVS patients compared to patients with COPD. Methods In this retrospective cohort study, 129 patients with COPD and 52 OVS patients were treated with NIV for ARF and followed up for a median of 1.8 years (IQR 3.8). We compared patient characteristics and overall survival. Results Compared to patients with COPD alone, OVS patients had higher prevalence of hypertension and type-2 diabetes mellitus. There was no difference in arterial pH, PaCO2 or serum bicarbonate at hospital presentation. Mortality was lower in OVS (HR 0.57, 95% CI 0.38-0.85) and remained lower after adjustment for age, gender, BMI, FEV1%predicted and comorbid cardiovascular disease. Median survival in OVS patients discharged home on NIV was significantly higher compared to OVS not discharged on therapy, as well as COPD patients, irrespective of home therapy prescription (p&amp;lt;0.01). Discussion OVS patients discharged on NIV had lower mortality compared to OVS patients not discharged on NIV. Patients with COPD and ARF requiring NIV have overall higher mortality rates compared to OVS patients. These findings suggest that following hospital admission with ARF, OVS patients may benefit from ongoing home NIV.

Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine

The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO2/FiO2 > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.