Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

Abstract

BackgroundRandomised control trial (RCT)-derived survival figures for acute exacerbation of chronic obstructive pulmonary disease admissions managed with non-invasive ventilation (NIV) have not been replicated in UK clinical audits. Subsequent guidelines have emphasised the need for timely NIV application.MethodsData from the 2008 and 2014 national chronic obstructive pulmonary disease audits was used to analyse the association between time to NIV and mortalityResults1032 patients received NIV in 2008, and 1612 in 2014. Overall mortality rates reduced between the audits from 24.9% in 2008 to 16.8% in 2014 but time to NIV lengthened. In 2014, 20.9% of patients received NIV within 60 min versus 24.9% in 2008 (p=0.001). The proportion of patients receiving NIV between 3 and 24 hours increased from 31.3% in 2008 to 39% in 2014 (p=0.001). Patients admitted with hypercapnic acidotic respiratory failure who received NIV within 3 hours had lower in-patient mortality than those who received NIV between 3 and 24 hours, 15.9% versus 18.4%, but this did not reach statistical significance (p=0.425), but acidotic patients receiving NIV >24 hours after admission had significantly higher mortality (28.9%, p=0.002). A second cohort admitted with hypercapnia but normal range pH, who developed later acidosis, had higher mortality (24.6%), compared with those acidotic on admission (18% p≤0.001) and an extremely high mortality when NIV was given >24 hours after admission (42.6%).ConclusionSurvival rates for those treated with NIV has improved between the two audits but remains lower than reported in RCTs. Patients who developed acidosis after admission and received NIV later in the hospital stay have even higher mortality and deserve further study and clinical attention.

Factors Influencing the Length of Hospital Stay Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospective Study of Inpatient Health Record

“…50 Regarding clinical interventions, 11.5% and 10.8% of the patients in this study used NIV and PR during hospitalization. The use prevalence of NIV and PR was consistent with what was reported about the COPD patients in UK (12.1% of COPD patients received NIV during hospitalization) 51 and US (only 1.5% initiated pulmonary rehabilitation within 90 days of their hospital discharge). 52 Both NIV and PR were associated with a longer LOS in this study.…”

High-pressure NIV for acute hypercapnic respiratory failure in COPD: improved survival in a retrospective cohort study

“…Mean age of the cohort was 71.0 (SD ±10.7) years, median FEV 1 39.0% (IQR 28.6–52.9) and median PaCO 2 before NIV 10.0 (IQR 8.5–11.2) kPa. Data from the national COPD audit in the UK in 2008 and 2014 showed a significantly improved in-hospital mortality of 24.9% and 16.8%, respectively 18. Findings were explained due to better adherence to guideline recommendations of ventilatory settings, although data on pressure settings were not recorded, as well as improvements of general care such as controlled oxygen and early antibiotic treatment.…”

“…Data from the national COPD audit in the UK in 2008 and 2014 showed a significantly improved in-hospital mortality of 24.9% and 16.8%, respectively. 18 Findings were explained due to better adherence to guideline recommendations of ventilatory settings, although data on pressure settings were not recorded, as well as improvements of general care such as controlled oxygen and early antibiotic treatment. Further retrospective data from the UK compared two cohorts, 2004–2010 and 2013–2017, of patients with COPD and first episode of ward‐based NIV.…”

Comparing effectiveness of intelligent volume‐assured pressure support (iVAPS) vs bi‐level positive airway pressure spontaneous/timed (BPAP S/T) for hypercapnic respiratory failure in chronic obstructive pulmonary disease

“…Furthermore, the mean length of hospital stay in BPAP S/T was found to be consistent with previous studies. 25,26 It is important to stress that no differences in terms of rate of ICU requirement and length of hospital stay were observed in iVAPS compared with BPAP S/T.…”