Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Objective Predictors of the need to initiate noninvasive ventilation (NIV) in stable COPD outpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) are insufficiently defined. The objective of this study was to investigate predictors of the need to initiate NIV in stable COPD-AE outpatients. Methods A total of 140 consecutive stable COPD outpatients who were hospitalized for COPD-AE for the first time were retrospectively examined. Demographic and clinical parameters measured in the stable state were evaluated, including data for arterial blood gases, the pulmonary function, body mass index and dyspnea scores. Results Of the 140 patients included, NIV was used in 32 (23%) patients. In a univariate Cox proportional hazards analysis, the baseline partial pressure of arterial carbon dioxide (PaCO2) (hazard ratio (HR), 1.14 per mmHg; 95% confidence interval (CI), 1.08-1.21) and forced expiratory volume in one second (FEV1)% predicted (HR, 1.03 per %; 95% CI, 1.01-1.05) were identified to be significant predictors. A multivariate logistic regression analysis showed only the PaCO2 (HR, 1.18 per mmHg; 95% CI, 1.12-1.26) to be a significant predictor. Conclusion Our results suggest that the PaCO2 measured in the stable state is an independent significant predictor of the need to initiate NIV in COPD-AE patients who are hospitalized for the first time.

Severity of nocturnal hypoxia and daytime hypercapnia predicts CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

“…Importantly, the present study extended these findings to patients who suffered from COPD and concurrent OSA, and demonstrated that CT90% and PCO 2 while awake predict CPAP failure in the OSA-COPD overlap syndrome. Interestingly, neither the severity of OSA nor the degree of airflow limitation independently predicted CPAP failure in the present study, which was in agreement with previous reports [23]. At present, it remains unknown whether initial PAP titration success relates to long-term favourable outcomes of PAP therapy in patients with OSA and concurrent COPD, and further studies are necessary to analyze such relationships.…”

“…Several reports have suggested that among unselected patients with severe COPD, the greatest physiological benefit of PAP is achieved in those with higher baseline PaCO 2 levels and in those who receive higher-pressure support and are more compliant [21][22][23]. Importantly, the present study extended these findings to patients who suffered from COPD and concurrent OSA, and demonstrated that CT90% and PCO 2 while awake predict CPAP failure in the OSA-COPD overlap syndrome.…”

COPD Patients Requiring Long-Term NIV Therapy: What Are the Critical Points in Monitoring the Efficacy of NIV?

“…However, data on its long-term beneficial effects are quite rare. Studies concerning where and how these patients should be followed up in the long term, the criteria for discontinuation and/or continuation of NIV therapy, and how the long-term effects of NIV therapy should be evaluated are limited in number [3,4].…”