Respiratory Care |

Role of Noninvasive Ventilation Instituted in Hospitalizations of Patients With Chronic Obstructive Pulmonary Disease and Acute Hypercapnic Respiratory Failure FREE TO VIEW

Maria João Oliveira, MS; Margarida Dias, MS; Inês Franco, MS; Sara Conde, MS
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Centro Hospitalar de Vila Nova de Gaia e Espinho, Arcozelo, Portugal

Chest. 2014;145(3_MeetingAbstracts):552A. doi:10.1378/chest.1834995
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SESSION TITLE: Non-Invasive Ventilation

SESSION TYPE: Slide Presentations

PRESENTED ON: Saturday, March 22, 2014 at 12:15 PM - 01:15 PM

PURPOSE: Evaluation of non invasive ventilation (NIV) instituted for the first time in hospitalizations of patients with exacerbation of chronic obstructive pulmonary disease (COPD) associated with acute hypercapnic respiratory failure (AHRF) and its prognosis.

METHODS: Retrospective study of patients admitted to the Pulmonology Department between 30/04/2010 and 30/04/2012, diagnosed with COPD and AHRF, to whom NIV was instituted for the first time and their prognosis. We excluded patients requiring invasive mechanical ventilation.

RESULTS: We evaluated 66 patients (48 men), mean age 70±14 years. The median hospitalization length was 14.0 days. 84.4% of the patients had severe obstruction (30≤ FEV1%predicted<50) or very severe (FEV1%predicted<30%). 12.1% died during hospitalization. Of the remaining patients, 53.4% discontinued NIV (35.5% by resolution of AHRF and 64.5% for intolerance). The NIV intolerance was significantly higher in patients with poor adherence to medication 14vs6 (p=0.001). The institution of domiciliary NIV was significantly higher in patients with severe obstruction, mean FEV1%predicted 45.1vs29.9% (p=0.005) and in patients with prior long term oxygen terapy 23vs2 (p=0.012). The pH, PaCO2, PaO2 and Charlson index, did not significantly influence the institution of domiciliary NIV. The number of hospitalizations per year was lower in patients with domiciliary NIV 26vs9 (p=0.002). Mortality was lower in patients with domiciliary NIV.

CONCLUSIONS: The successful institution of NIV improved the prognosis of patients by reducing the number of hospital readmissions and mortality. The degree of obstruction did not influence the institution of domiciliary NIV.

CLINICAL IMPLICATIONS: Exacerbations of COPD are acute episodes of clinical worsening and a frequent cause of hospital admission. When complicated with AHRF, NIV has shown to be a tool that improves the prognosis of the patient.

DISCLOSURE: The following authors have nothing to disclose: Maria João Oliveira, Margarida Dias, Inês Franco, Sara Conde

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