Utility of respiratory ward‐based <scp>NIV</scp> in acidotic hypercapnic respiratory failure

Dave, Chirag; Turner, Alice; Thomas, Ajit; Beauchamp, Ben; Chakraborty, B. N.; Ali, Asad; Mukherjee, Rahul; Banerjee, Dev

doi:10.1111/resp.12366

Cited by 22 publications

(23 citation statements)

References 17 publications

(45 reference statements)

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“…The inclusion of only patients at first presentation is due to the differences that have been identified previously in the literature and specifically in this cohort. This has including the more rapid progression from ED onto the NIV service of those who are on the second or later presentation, which presumably occurs due to their pre-identified risk factor of prior NIV, and proven previous efficacy of NIV treatment [16].…”

Section: Discussionmentioning

confidence: 99%

Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV

Trethewey

Edgar

Morlet

et al. 2019

Respiratory Medicine

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Section: Discussionmentioning

confidence: 99%

Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV

Trethewey

Edgar

Morlet

et al. 2019

Respiratory Medicine

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“…A recent analysis 130 of UK COPD patients followed after one or more hospital admissions requiring NIV found mortality rates of between 45% and 57% at 1 year, between 62% and 68% at 3 years and between 72% and 75% at 5 years. This was broadly consistent with the 1-year mortality rates in the usual-care arm of one post-hospital study 97 included in this report.…”

Section: Generalisability Of Findingsmentioning

confidence: 99%

“…129 Applying these risks and the all-cause mortality risk reported in Garcia-Aymerich et al (2003), 152 and assuming they remained constant for the cohort's lifetime, the model projected cumulative mortality similar to that reported in long-term (5-year) studies. 86,130 The mortality rates reported in post-hospital studies and cohorts of COPD patients discharged from hospital are reported in Appendix 13 and the baseline survival curves for the stable and post-hospital populations are illustrated in Appendix 15.…”

Section: Economic Evaluationmentioning

confidence: 99%

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Dretzke

Blissett

Dave

et al. 2015

Health Technol Assess

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BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation.Data sourcesBibliographic databases, conference proceedings and ongoing trial registries up to September 2014.MethodsStandard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately.ResultsThirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective.LimitationsEvidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data.ConclusionsThe cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings.Future work recommendationsThe results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV.Study registrationThis study is registered as PROSPERO CRD42012003286.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…[ 13 ] Dave reviewed outcomes in 498 patients requiring 731 admissions for acute hypercapneic respiratory failure, including 109 patients who required noninvasive ventilation. [ 17 ] Admission glucose levels were similar in patients managed on the ward and patients managed in a high dependency unit or ICU. Our studies did not identify a relationship between LOS, mortality, or re-admission.…”

Section: Discussionmentioning

confidence: 98%

The association between glucose levels and hospital outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease

et al. 2015

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BACKGROUND:Corticosteroids used for chronic obstructive pulmonary disease (COPD) exacerbations can cause hyperglycemia in hospitalized patients, and hyperglycemia may be associated with increased mortality, length of stay (LOS), and re-admissions in these patients.MATERIALS AND METHODS:We did three retrospective studies using charts from July 2008 through June 2009, January 2006 through December 2010, and October 2010 through March 2011. We collected demographic and clinical information, laboratory results, radiographic results, and information on LOS, mortality, and re-admission.RESULTS:Glucose levels did not predict outcomes in any of the studied cohorts, after adjustment for covariates in multivariable analysis. The first database included 30 patients admitted to non-intensive care unit (ICU) hospital beds. Six of 20 non-diabetic patients had peak glucoses above 200 mg/dl. Nine of the ten diabetic patients had peak glucoses above 200 mg/dl. The maximum daily corticosteroid dose had no apparent effect on the glucose levels. The second database included 217 patients admitted to ICUs. The initial blood glucose was higher in patients who died than those who survived using bivariate analysis (P = 0.015; odds ratio, OR, 1.01) but not in multivariable analysis. Multivariable logistic regression analysis also demonstrated that glucose levels did not affect LOS. The third database analyzing COPD re-admission rates included 81 patients; the peak glucose levels were not associated with re-admission.CONCLUSIONS:Our data demonstrate that COPD patients treated with corticosteroids developed significant hyperglycemia, but the increase in blood glucose levels did not correlate with the maximum dose of corticosteroids. Blood glucose levels were not associated with mortality, LOS, or re-admission rates.

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Utility of respiratory ward‐based NIV in acidotic hypercapnic respiratory failure

Abstract: NIV could be used on medical wards for patients with pH 7.16 or greater on their first admission, although more conservative values should continue to be used for those with a second or subsequent episodes of AHRF.

Cited by 22 publications

References 17 publications

Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV

Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

The association between glucose levels and hospital outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease

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