Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD

Kitajima, Takamasa; Marumo, Satoshi; Shima, Hiroshi; Shirata, Masahiro; Kawashima, Satoru; Inoue, Daiki; Katayama, Yuko; Itotani, Ryo; Sakuramoto, Minoru; Fukui, Motonari

doi:10.2147/copd.s153200

Cited by 16 publications

(19 citation statements)

References 34 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the recent HOT-HMV trial, there was a statistically significant reduction in nocturnal P tcCO 2 levels on the night after initiation of NIV, which reportedly persisted to 12 months [62]. Finally, uncontrolled nocturnal hypoventilation seems to be related to increased risk of exacerbations and pulmonary hypertension [121]. End tidal carbon dioxide monitoring should never be used to approximate P aCO 2 in patients with COPD during spontaneous breathing or NIV, and is even less reliable in patients with invasive ventilation [122,123] In recent years, improvements introduced by manufacturers in their models have led these devices to act both as ventilators and monitors.…”

Section: Narrative Question 2: How Can Clinicians Monitor and Follow-mentioning

confidence: 95%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

View full text Add to dashboard Cite

BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

show abstract

Section: Narrative Question 2: How Can Clinicians Monitor and Follow-mentioning

confidence: 95%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

View full text Add to dashboard Cite

show abstract

“…As mentioned above, during REM sleep, desaturation tends to be caused by enhanced alveolar hypoventilation (socalled REM sleep-related hypoventilation) and exhibits the characteristic SpO2 pattern (14)(15)(16)(17). We assume that the clinical condition of the periodic pattern reflects this REM sleep-related hypoventilation because it showed that the SpO2 dropped at a cycle of approximately 90-120 minutes, and the waveform was similar to that mentioned in previous reports (14)(15)(16). O'Donoghue et al (18) reported that REM sleep-related hypoventilation was associated with daytime PaCO2 and a high BMI, but our study did not support their findings.…”

Section: Discussionmentioning

confidence: 99%

Prospective Study of Nocturnal Desaturation in Patients Receiving Home Oxygen Therapy

et al. 2021

View full text Add to dashboard Cite

Objective Nocturnal desaturation is common in patients with chronic respiratory disease and often worsens the prognosis. Therefore, it should be diagnosed accurately and appropriately treated. The aim of this study was to clarify the diversity of nocturnal desaturation. Methods We prospectively enrolled 58 outpatients diagnosed with chronic respiratory disease receiving home oxygen therapy and measured nocturnal SpO2 using a portable oximeter. We classified nocturnal desaturation (3% decrease in SpO2 from baseline) into three patterns: periodic pattern (desaturation duration of <655 seconds), sustained pattern (desaturation duration of " 655 seconds), and intermittent pattern (desaturation and recovery of SpO2 repeated with a cycle of several minutes). Results Nocturnal hypoxemia (SpO2 ! 88% for more than 5 minutes) was found in 23.8% of patients. The percentage of patients with chronic obstructive pulmonary disease (COPD) was significantly higher in the nocturnal hypoxemia group than in the non-hypoxemia group (80% vs. 40.6%, p=0.03). Desaturation with a periodic pattern was found in 81% of patients, desaturation with a sustained pattern was found in 40.5% of patients, and desaturation with an intermittent pattern was found in 59.5% of patients. In patients with COPD, desaturation with a periodic pattern was found in 85.7%, desaturation with a sustained pattern was found in 47.6%, and desaturation with an intermittent pattern was found in 57.1%. Conclusion The SpO2 waveform of nocturnal hypoxemia was able to be classified into three patterns. Suitable treatment for each pattern might improve the prognosis of these patients.

show abstract

“…In other words, it is possible that patients in this group might be exposed to severe hypoxemia regardless of the severity of COPD. Even in patients with COPD without daytime hypoxemia, it has been reported that desaturations can occur due to complications such as obstructive sleep apnoea (OSA) and rapid eye movement (REM) sleep-related hypoventilation [ 19 , 20 ]. It is suggested that there is a population exposed to severe hypoxemia due to overlap of pathophysiologies, such as apnoea and hypoventilation.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the nocturnal desaturation waveform pattern of SpO2 in COPD patients: an observational study

et al. 2021

View full text Add to dashboard Cite

Background Nocturnal desaturation is common in patients with chronic obstructive pulmonary disease (COPD) and impacts disease exacerbation and prognosis. In our previous study, we developed a diagnostic algorithm to classify nocturnal desaturation from SpO2 waveform patterns based on data from patients receiving home oxygen therapy. In this study, we aimed to investigate nocturnal desaturation in patients with COPD based on SpO2 waveform patterns and the associations between the waveforms and clinical data. Methods We investigated patients diagnosed with COPD and measured SpO2 and nasal airflow with a type 4 portable long-term recordable pulse oximeter. Then, we classified the SpO2 waveforms with the algorithm and compared the clinical data. Results One hundred fifty-three patients (136 male and 17 female) were analysed. One hundred twenty-eight of the 153 (83.7%) patients had nocturnal desaturation, with an intermittent pattern (70.6%), sustained pattern (13.1%) and periodic pattern (68.0%). Intriguingly, desaturation with an intermittent pattern was associated with the apnoea-hypopnea index obtained with the portable monitor, and desaturation with a sustained pattern was associated with the cumulative percentage of time at a SpO2 below 90%. Conclusions We found that nocturnal desaturation was frequently observed in patients with COPD and could be classified into 3 types of waveform patterns.

show abstract

Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD

Cited by 16 publications

References 34 publications

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

Prospective Study of Nocturnal Desaturation in Patients Receiving Home Oxygen Therapy

Characteristics of the nocturnal desaturation waveform pattern of SpO2 in COPD patients: an observational study

Contact Info

Product

Resources

About