Role of domiciliary noninvasive ventilation in chronic obstructive pulmonary disease patients requiring repeated admissions with acute Type II respiratory failure: A prospective cohort study

Abstract

Chronic obstructive pulmonary disease (COPD) is the 4 th leading cause of death in the world and is projected to be the 3 rd leading cause of death by 2020 as per GOLD 2017. Globally, the prevalence of COPD is alarmingly rising in countries of all levels of development. Hence in the arena of management, more importance is being given to modify the disease process, to provide better medical care and thus reduce the burden on patients, caregivers, and society. Main factors that determine the prognosis include frequency of exacerbations and respiratory failure, which may or may not require ventilator assistance. Advances in technology have revolutionized mechanical ventilation. Over the past three decades, the application of noninvasive ventilation (NIV) has emerged as a core therapy in the management of patients with acute and chronic respiratory failure. It has become an integral tool in the management of respiratory failure, in both home setting and the critical care units. ckground: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with acute hypercapnic respiratory failure (AHRF) is associated with high mortality and increased risk for further exacerbations and hospitalization. While there is ample evidence regarding the benefit of noninvasive ventilation (NIV) during AECOPD, evidence supporting long-term noninvasive ventilation (LTNIV) for more stable COPD patients is limited. Objective: The aim of this study is to assess the effectiveness of LTNIV in COPD patients requiring frequent hospital admissions and NIV support for AHRF. Materials and Methods: A prospective cohort study including 120 patients having survived an admission requiring NIV support for AHRF due to COPD, with a history of 3 similar episodes in the past year. Patients were advised LTNIV (30) with standard treatment, or (90) standard treatment alone. Both groups were followed up for 1 year. Among non-NIV group 10 died, and 8 lost follow-up, whereas two died in NIV group. The primary endpoint was death. Data of remaining 100 patients were analyzed for other objectives-number of readmissions, AHRF, Intensive Care Unit (ICU)/ventilator requirement, dyspnea, quality of life, exercise tolerance, lung function, and arterial blood gases. Results: LTNIV group had 40% reduction in mortality (6.6% vs. 11.1%). There was significant reduction in number of hospital admissions (28.6% vs. 84.7%: P <0.05), ICU admissions (7.1% vs. 56.9%: P = 0.01), ventilator requirement (3.6% vs. 30.6%: P = 0.003), AHRF (7.1% vs. 48.6%: P = 0.000) and improvement in partial arterial CO 2 pressure (39.8 2.1 vs. 57.03 3.7 mmHg) and severe respiratory insufficiency score (P < 0.05) among LTNIV group, but no significant change in lung function and exercise tolerance. Conclusion: Patients tolerated LTNIV well and had a better outcome compared to those without NIV. LTNIV may be considered in patients with recurrent AHRF.