Prospective cross-sectional multicenter study on domiciliary noninvasive ventilation in stable hypercapnic COPD patients

Abstract

BackgroundDomiciliary noninvasive ventilation (NIV) use in stable hypercarbic COPD is becoming increasingly widespread. However, treatment compliance criteria and factors related to compliance remain to be defined.MethodsThis research was designed as a prospective, cross-sectional, multicenter real-life study. Chronic hypercapnic COPD patients who were using domiciliary NIV for at least 1 year and being followed up in 19 centers across Turkey were included in the study. The patients who used NIV regularly, night or daytime and ≥5 hours/d, were classified as “high-compliance group,” and patients who used NIV irregularly and <5 hours/d as “low-compliance group.”ResultsTwo hundred and sixty-six patients with a mean age of 64.5±10.3 years were enrolled, of whom 75.2% were males. They were using domiciliary NIV for 2.8±2 years. Spontaneous time mode (p<0.001) and night use (p<0.001) were more frequent in the high-compliance group (n=163). Also, mean inspiratory positive airway pressure values of the high-compliance group were significantly higher than the low-compliance group (n=103; p<0.001). Cardiac failure (p=0.049) and obesity (p=0.01) were significantly more frequent in the high-compliance group. There were no difference between 2 groups regarding hospitalization, emergency department and intensive care unit admissions within the last year, as well as modified Medical Research Council dyspnea and COPD Assessment Test scores. With regard to NIV-related side effects, only conjunctivitis was observed more frequently in the high-compliance group (p=0.002).ConclusionDetermination of the patients who have better compliance to domiciliary NIV in COPD may increase the success and effectiveness of treatment. This highly comprehensive study on this topic possesses importance as it suggests that patient and ventilator characteristics may be related to treatment compliance.

Current Practices in Home Mechanical Ventilation for Chronic Obstructive Pulmonary Disease: A Real-Life Cross-Sectional Multicentric Study

“…Regarding the preferred interface, we found a huge shift from the Eurovent study where the vast majority of countries reported ventilation through a nasal mask in lung HMV users (especially Portugal). 10 These findings are in line with recent studies in COPD patients suggesting a change in practice in recent years and it is probably a consequence of the use of higher ventilation pressures 12,[23][24][25] and improved monitoring capacity due to ventilator software readouts. 26 In this study population, there were no patients with invasive ventilation via tracheostomy.…”

<p>Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial</p>

“…Dreher et al29 observed in a crossover study that higher inspiratory pressures were not only related to more effective CO 2 reduction but also to better ventilator usage . Yazar et al30 found in a cross-sectional prospective study design in 266 patients that higher inspiratory pressures were associated with higher usage times . Thus better adherence as seen during controlled ventilation in the present study could possibly be explained by a higher efficacy of this ventilation mode.…”