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Wien Klin Wochenschr. 2018 Oct;130(19-20):561-568. doi: 10.1007/s00508-018-1364-6. Epub 2018 Jul 31.

Long-term outcomes after acute hypercapnic COPD exacerbation : First-ever episode of non-invasive ventilation.

Author information

1
Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria.
2
Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
3
Department of Respiratory Medicine and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria. georg-christian.funk@meduniwien.ac.at.
4
Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria. georg-christian.funk@meduniwien.ac.at.
5
Medical University of Vienna, Vienna, Austria. georg-christian.funk@meduniwien.ac.at.

Abstract

BACKGROUND:

Non-invasive ventilation (NIV) is used to treat acute hypercapnic respiratory failure (AHRF) in patients with chronic obstructive pulmonary disease (COPD); however, long-term outcomes following discharge are largely unknown. This study aimed to characterize long-term outcomes and identify associated markers in patients with COPD after surviving the first episode of HRF requiring NIV.

METHODS:

This study retrospectively analyzed 122 patients, mean age 62 ± 8 years, 52% female and forced expiratory volume in 1 s (FEV1) predicted 30 ± 13%, admitted with an acute hypercapnic exacerbation of COPD and receiving a first-ever NIV treatment between 2000 and 2012.

RESULTS:

A total of 40% of the patients required hospital readmission due to respiratory reasons within 1 year. Persistent hypercapnia leading to the prescription of domiciliary NIV, older age and lower body mass index (BMI) were risk factors for readmission due to respiratory reasons. Survival rates were 79% and 63% at 1 and 2 years after discharge, respectively. A shorter time to readmission and recurrent hypercapnic failure, lower BMI and acidemia on the first admission, as well as hypercapnia at hospital discharge were correlated with a decreased long-term survival.

CONCLUSION:

Patients with COPD surviving their first episode of AHRF requiring NIV are at high risk for readmission and death. Severe respiratory acidosis, chronic respiratory failure and a lower BMI imply shorter long-term survival.

KEYWORDS:

COPD; COPD exacerbation; Long-term outcome; Non-invasive ventilation

PMID:
30066095
PMCID:
PMC6209011
DOI:
10.1007/s00508-018-1364-6
[Indexed for MEDLINE]
Free PMC Article

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