Non-invasive ventilation (NIV) is widely used in episodes of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) patients. However, there is no evidence on the efficacy of NIV during similar episodes in obesity-hypoventilation syndrome (OHS). We therefore compared the efficacy of NIV in episodes of AHRF due to OHS and COPD.
METHODS: We prospectively assessed 716 consecutive patients (173 with OHS and 543 with COPD) with AHRF (arterial pH <7.35 and PaCO2 >45 mmHg) treated with a similar protocol of NIV. We defined successful NIV as avoidance of intubation and ICU survival at least 24 hours in the ward. Hospital survivors were followed for 1 year to assess hospital readmission and survival.
RESULTS: Both groups had similar (mean±SD) baseline respiratory acidosis (arterial pH, 7.22±0.08; PaCO2, 86±21 mmHg). Patients with OHS were older (74±11 vs. 71±10 years, p<0.001), were more frequently female (134, 77% vs. 66, 12%, p<0.001), had less late NIV failure (12, 7% vs. 67, 13%, p=0.037), lower hospital mortality (10, 6% vs. 96, 18%, p<0.001) and higher one-year survival (odds-ratio 1.83, 95% confidence interval 1.24-2.69, p=0.002). However, survival adjusted for confounders (adjusted odds-ratio 1.41, 95% confidence interval 0.70-2.83, p=0.34), NIV failure (11, 6% vs. 59, 11%, p=0.11), length of stay and hospital readmission were similar in both groups. Among COPD patients, obesity was associated with less late NIV failure and hospital readmission.
CONCLUSION: Patients with OHS can be treated with NIV during an episode of AHRF with similar efficacy and better outcomes than COPD patients.
Authors: Carrillo A, Ferrer M, Gonzalez-Diaz G, Lopez-Martinez A, Llamas N, Alcazar M, Capilla L, Torres A
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