The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning
Article first published online: 27 OCT 2011
© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology
Volume 16, Issue 8, pages 1273–1280, November 2011
How to Cite
HEINEMANN, F., BUDWEISER, S., JÖRRES, R. A., ARZT, M., RÖSCH, F., KOLLERT, F. and PFEIFER, M. (2011), The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning. Respirology, 16: 1273–1280. doi: 10.1111/j.1440-1843.2011.02054.x
- Issue published online: 27 OCT 2011
- Article first published online: 27 OCT 2011
- Accepted manuscript online: 24 AUG 2011 11:40AM EST
- Received 3 May 2011; invited to revise 8 June 2011; revised 26 June 2011; accepted 5 July 2011 (Associate Editor: Amanda Piper).
- chronic obstructive pulmonary disease;
- home mechanical ventilation;
- non-invasive positive pressure ventilation;
- respiratory failure;
Background and objective: Patients with COPD who require prolonged weaning from invasive mechanical ventilation show poor long-term survival. Whether non-invasive home mechanical ventilation (HMV) has a beneficial effect after prolonged weaning has not yet been clearly determined.
Methods: Patients with COPD who required prolonged weaning and were admitted to a specialized weaning centre between January 2002 and February 2008 were enrolled in the study. Long-term survival and prognostic factors, including the role of non-invasive HMV, were evaluated.
Results: Of 117 patients (87 men, 30 women; mean age 69.5 ± 9.5 years) included in the study, weaning from invasive ventilation was achieved in 82 patients (70.1%). Successful weaning was associated with better survival 1 year after discharge from hospital (hazard ratio (HR) 2.24, 95% CI: 1.16–4.31; P = 0.016). Among the 82 patients who were successfully weaned, non-invasive HMV was initiated in 39 (47.6%) due to persistent chronic ventilatory failure. Initiation of HMV was associated with a higher rate of survival to 1 year as compared with patients who did not receive ventilatory support (84.2% vs 54.3%; HR 3.68, 95% CI: 1.43–9.43; P = 0.007). In addition, younger age and higher PaO2, haemoglobin concentration and haematocrit at discharge were associated with better survival. In an adjusted multivariate analysis, initiation of non-invasive HMV after successful weaning remained an independent prognostic factor for survival to 1 year (HR 3.63, 95% CI: 1.23–10.75; P = 0.019).
Conclusions: These findings suggest that based on the potential for improvement in long-term survival, non-invasive HMV should be considered in patients with severe COPD and persistent chronic hypercapnic respiratory failure after prolonged weaning.