Survival of Hypercapnic Patients with COPD and Obesity Hypoventilation Syndrome Treated with High Intensity Non Invasive Ventilation in the Daily Routine Care

Blankenburg, Thomas; Benthin, Christin; Pohl, Stefanie; Bramer, Anett; Kalbitz, F.; Lautenschläger, Christine; Schütte, Wolfgang

doi:10.2174/1874306401711010031

Cited by 18 publications

(10 citation statements)

References 21 publications

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“…This somewhat unexpected finding might be due to better health behaviours in subjects with diabetes and cancer survivors. Although our results may also be partly due to the lack of power or coincident results related to multiple statistical testing, they highlight the need for comprehensive care of patients treated with The subjects in this study were adherent to NIV, with a median of 6 h. Our results are in line with those of the study by Blankenburg et al, although the discontinuation percentages in subjects with COPD and OHS in our study were slightly lower [18]. Moreover, discontinuation was not associated with survival in the subjects in the current study, even though discontinuation has previously been shown to be associated with worse survival in subjects with OHS [25].…”

Section: Discussionsupporting

confidence: 87%

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Survival and end-of-life aspects among subjects on long-term noninvasive ventilation

Rantala

Leivo-Korpela

Kettunen

et al. 2020

European Clinical Respiratory Journal

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Background: The need for noninvasive ventilation (NIV) is commonly considered a predictor of poor survival, but life expectancy may vary depending on the underlying disease. We studied the factors associated with decreased survival and end-of-life characteristics in an unselected population of subjects starting NIV. Methods: We conducted a retrospective study including 205 subjects initiating NIV from 1/1/ 2012-31/12/2015 who were followed up until 31/12/2017. Results: The median survival time was shorter in subjects needing help with activities of daily living than in independent subjects (hazard ratio (HR) for death 1.7, 95% CI 1.2-2.6, P = 0.008) and was also shorter in subjects on long-term oxygen therapy (LTOT) than in those not on LTOT (HR for death 2.8, 95% CI 1.9-4.3, P < 0.001). There was marked difference in survival according to the disease necessitating NIV, and subjects with amyotrophic lateral sclerosis or interstitial lung disease seemed to have the shortest survival. The two most common diseases resulting in the need for NIV were chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS). The median survival time was 4.4 years in COPD subjects, but the median survival time was not reached in subjects with OHS (HR for death COPD vs. OHS: 3.2, 95% CI 1.9-5.5, P < 0.001). Most of the deceased subjects (55.6%) died in the hospital, while only 20.0% died at home. The last hospitalization admission leading to death occurred through the emergency room in 44.4% of the subjects. Conclusions: Survival among subjects starting NIV in this real-life study varied greatly depending on the disease and degree of functional impairment. Subjects frequently died in the hospital after admission through the emergency department. A comprehensive treatment approach with timely advance care planning is therefore needed, especially for those needing help with activities of daily living and those with both NIV and LTOT.

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Section: Discussionsupporting

confidence: 87%

“…was slightly better than that identified in a study by Blankenburg et al (3.9 yrs. ), while a relatively long survival of OHS subjects was found in both studies[ 18 ]. Subjects with other diagnoses showed very variable prognoses in our study.…”

Section: Discussionmentioning

confidence: 90%

Survival and end-of-life aspects among subjects on long-term noninvasive ventilation

Rantala

Leivo-Korpela

Kettunen

et al. 2020

European Clinical Respiratory Journal

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“…Additionally, several observational studies and uncontrolled trials indicated that LTMV has a positive effect on survival in patients with NMD [10–16], OHS [10, 13, 17–20] and CWD [10–13, 21–23] relative to historical controls.…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life as predictor for mortality in patients treated with long-term mechanical ventilation

et al. 2019

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BackgroundThe Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV). The aim of the present study was to examine whether SRI sum scores and related subscales are associated with mortality in LTMV patients.MethodsThe study included 112 LTMV patients (non-invasive and invasive) from the Norwegian LTMV registry in Western Norway from 2008 with follow-up in August 2014. SRI data were obtained through a postal questionnaire, whereas mortality data were obtained from the Norwegian Cause of Death Registry. The SRI questionnaire contains 49 items and seven subscales added into a summary score (range 0–100) with higher scores indicating a better HRQoL. The association between the SRI score and mortality was estimated as hazard ratios (HRs) with 95% confidence intervals (95% CI) using Cox regression models and HRs were estimated per one unit change in the SRI score.ResultsOf the 112 participating patients in 2008, 52 (46%) had died by August 2014. The mortality rate was the highest in patients with chronic obstructive pulmonary disease (75%), followed by patients with neuromuscular disease (46%), obesity hypoventilation syndrome (31%) and chest wall disease (25%) (p < 0.001). Higher SRI sum scores in 2008 were associated with a lower mortality risk after adjustment for age, education, hours a day on LTMV, time since initiation of LTMV, disease category and comorbidity (HR 0.98, 95% CI: 0.96–0.99). In addition, SRI-Physical Functioning (HR 0.98, 95% CI: 0.96–0.99), SRI-Psychological Well-Being (HR 0.98, 95% CI: 0.97–0.99), and SRI-Social Functioning (HR 0.98, 95% CI: 0.97–0.99) remained significant risk factors for mortality after covariate adjustment. In the subgroup analyses of patient with neuromuscular diseases we found significant inverse associations between some of the SRI subscales and mortality.ConclusionsSRI score is associated with mortality in LTMV-treated patients. We propose the use of SRI in the daily clinic with repeated measurements as part of individual follow-up. Randomized clinical trials with interventions aimed to improve HRQoL in LTMV patients should consider the SRI questionnaire as the standard HRQoL measurement.Electronic supplementary materialThe online version of this article (10.1186/s12890-018-0768-4) contains supplementary material, which is available to authorized users.

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“…We identified 32 articles: 27 were single-arm case series ( 3 , 14 , 16 , 23 – 26 , 28 , 54 – 72 ), 2 were observational studies with a control group published in abstract form ( 29 , 73 ), and 3 were RCTs ( 11 , 19 , 21 ).…”

Section: Resultsmentioning

confidence: 99%

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

Mokhlesi¹,

Masa²,

Brožek³

et al. 2019

Am J Respir Crit Care Med

189

146

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; on behalf of the American Thoracic Society Assembly on Sleep and Respiratory Neurobiology THIS OFFICIAL CLINICAL PRACTICE GUIDELINE OF THE AMERICAN THORACIC SOCIETY WAS APPROVED MAY 2019 Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS). Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations. Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level ,27 mmol/L to exclude the diagnosis of OHS in obese patients with sleepdisordered breathing when suspicion for OHS is not very high (,20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respiratory failure and suspected of having OHS be discharged with noninvasive ventilation until they undergo outpatient diagnostic procedures and PAP titration in the sleep laboratory (ideally within 2-3 mo), and 5) patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery). Conclusions: Clinicians may use these recommendations, on the basis of the best available evidence, to guide management and improve outcomes among patients with OHS.

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Survival of Hypercapnic Patients with COPD and Obesity Hypoventilation Syndrome Treated with High Intensity Non Invasive Ventilation in the Daily Routine Care

Abstract: Abstract:Background:

Cited by 18 publications

References 21 publications

Survival and end-of-life aspects among subjects on long-term noninvasive ventilation

Survival and end-of-life aspects among subjects on long-term noninvasive ventilation

Health-related quality of life as predictor for mortality in patients treated with long-term mechanical ventilation

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

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