0
Editorials |

Decision Making in Chronic Hypercapnic Respiratory Failure: A Real Challenge!

Emiel F. M. Wouters, MD, FCCP
Author and Funding Information

Affiliations: Maastricht, the Netherlands ,  Dr. Wouters is Professor in Respiratory Medicine and Chairman, Department of Respiratory Medicine, University Hospital Maastricht.

Correspondence to: Emiel F. M. Wouters, MD, FCCP, Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, the Netherlands; e-mail: e.wouters@lung.azm.nl



Chest. 2007;131(6):1622-1624. doi:10.1378/chest.07-0412
Text Size: A A A
Published online

Extract

COPD is an irreversible disabling disease with increasing incidence worldwide. Patients with COPD frequently suffer in the end stage of the disease process from chronic hypercapnic respiratory failure (CHRF). Although high level of evidence has shown that adding noninvasive positive pressure ventilation (NIPPV) in addition to standard therapy with oxygen and medication is effective in the management of episodes of acute respiratory failure in patients with acute exacerbations of COPD,1 the role of NIPPV on long-term survival in CHRF is still a topic of controversy despite the wide application of NIPVV in chronic hypercapnic patients.23 Prognostic parameters have not been evaluated under these conditions, although patients are at high risk for readmission and life-threatening events. The study by Budweiser et al4 in this issue of CHEST (see page 1650) evaluated prognostic markers of long-term survival in patients with severe COPD and CHRF receiving NIPVV. The study comprised a 10-year observation period, a mean follow-up of 32 months, and included 188 patients treated with NIPVV. The study pointed out that nutritional status assessed by body mass index (BMI), hyperinflation, and base excess (BE) independently predicted mortality. A reduction of these risk factors after initiation of NIPVV (increase in BMI in patients with BMI < 25 kg/m2; a decrease of residual volume [RV]/total lung capacity [TLC] by ≥ 4% in patients with RV/TLC ≥ 73% and a reduction in BE ≥ 50% if baseline BE is ≥ 9 mmol/L) was associated with improved survival.,4

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543