Long-Term Home Non-Invasive Ventilation in Patients with Severe COPD with Hypercapnic Respiratory Failure: Impact on Long-Term Survival, Exacerbations and Mortality Related Factors
Background: Non-invasive ventilation (NIV) improves outcomes in acute life-threatening hypercapnic respiratory failure due to exacerbations of COPD (ECOPD), but the benefits of long-term home NIV (LTH-NIV) for managing hypercapnic chronic respiratory failure (CRF) in COPD remain unclear. Purpose: 1)...
| Autores: | , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repositorio: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:i3pt.fundanetsuite.com:p6640 |
| Acceso en línea: | https://i3pt.portalinvestigacion.com/publicaciones/6640 |
| Access Level: | acceso abierto |
| Palabra clave: | long-term home non-invasive ventilation COPD chronic respiratory failure exacerbations survival mortality |
| Sumario: | Background: Non-invasive ventilation (NIV) improves outcomes in acute life-threatening hypercapnic respiratory failure due to exacerbations of COPD (ECOPD), but the benefits of long-term home NIV (LTH-NIV) for managing hypercapnic chronic respiratory failure (CRF) in COPD remain unclear. Purpose: 1) To assess the long-term survival of severe COPD patients with hypercapnic CRF started on LTH-NIV and mortality related factors; 2) To evaluate the impact of LTH-NIV on ECOPD and hospital admissions at follow-up. Patients and Methods: COPD patients who started LTH-NIV between January 2009 and December 2018 were included. Medical records and clinical outcomes were retrospectively reviewed. Results: Forty-four COPD patients (mean [SD] age 66.5 [10.4] years, 81.8% men) with severe airflow obstruction (mean [SD] FEV1 36 [16] % of predicted), hypercapnic CRF (mean [SD] PaCO2 60.8 [9.2] mmHg) and exacerbator phenotype (mean [IQR] moderatesevere ECOPD 3 [3] in previous year) were included. Median survival from LTH-NIV was 100.3 months. Survival at one, three and five years was 86.4%, 72.7% and 68.2%, respectively. In a multivariate Cox regression model, patients with a significantly increased risk of death were those with older age, lower absolute FVC, more hospitalisations and especially those adapted to LTH-NIV in the acute phase (HR 3.67 (IC 1.04-13), p<0.05). LTH-NIV allowed an estimated mean reduction in ECOPD of 39.7% (65.2% in hospitalisations) at 12 months and 57.4% (81% in hospitalisations) at 24 months. Conclusion: The survival rate of COPD patients with hypercapnic CRF on LTH-NIV is currently high (>50% at 5 years). Adaptation to LTH-NIV in the stable phase is the most important prognostic determinant and should be considered especially in patients with more hospitalisations and lower FVC values. Initiation of LTH-NIV reduces moderate to severe ECOPD at follow-up. |
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