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Prognosis and Evolution of COPD Patients Hospitalized and Treated With Noninvasive Ventilation FREE TO VIEW

Andrés Vega Arias, MD; Jesús Sánchez, MD; Virginia Almadana, MD; Maria Pavon, MD; Patricia Guerrero, MD; Natalia Fouz, MD; Ana Gómez-Bastero, MD; Juan Polo, MD; Teodoro Montemayor, MD
Author and Funding Information

H. U. V. Macarena, Sevilla, Spain

Chest. 2014;145(3_MeetingAbstracts):545A. doi:10.1378/chest.1783285
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SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Non invasive ventilation (NIV) in COPD patients with acute respiratory failure (ARF) is a clearly effective treatment. The long-term prognosis of COPD patients who required NIV during the hospital admission is not known exactly.OBJECTIVES: To evaluate the short and long term prognosis of COPD patients admitted in the hospital with an episode of hypercapnic ARF who required NIV.

METHODS: Prospective study, consecutive inclusion of COPD patients admitted from February 2009 to April-2012 because ARF with acidosis and hypercapnia and who were treated with NIV. A group of patients were discharged home with BiPAP ( especially if they had previous admissions for ARF, dypsnea on minimal exertion, and high PaCO2 values) . We proceeded to analyse mortality and readmissions from the discharge date to September 2012.

RESULTS: N= 263; Mean Age: 73±11 yr.; Males 93%; Symptoms of sleep apnea 15%; Obesity: 37%; Smokers 14%; Ex-smokers 83%; Mean number of previous admissions with ARF: 2.33± 3.65; ;FEV1:46±19 %; Initial pH: 7.25± 0.1; Initial PaCO2: 80±20 mmHg The hospital mortality was: 13%. Important factors in hospital mortality were: older age, more previous admissions, lower pH and higher PaCO2 at the begining and in the end of the hospitalization, the need for higher FiO2 and patients with therapeutic effort limitation : all of these items p<0,005. During follow up: N= 229 patients, the outside mortality was 51,52% and the mean survival rate was 770 days. Features that inceases the mean survival rate with p<0,005 include: younger age, obesity, sleep apnea symptoms and fewer respiratoy readmissions. Analyzing the survival rate between patients with BIPAP vs without BiPAP we obtained an average of 928 days in the first group vs 778 days in the second group (p=n.s)

CONCLUSIONS: 1. In our study, mortality during hospital admission of COPD patients with ARF treated with NIV is low (12.92%). 2. Mortality in these patients during follow-up was high (51.52%), being higher in older patients and who had more number of readmissions; remaining similar in those who were discharged at home with and without NIV.

CLINICAL IMPLICATIONS: COPD patients with exacerbations with ARF with who needs NIV are at high rish of death

DISCLOSURE: The following authors have nothing to disclose: Andrés Vega Arias, Jesús Sánchez, Virginia Almadana, Maria Pavon, Patricia Guerrero, Natalia Fouz, Ana Gómez-Bastero, Juan Polo, Teodoro Montemayor

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