2008 A Randomized Controlled Trial of Continuation of Home Non-invasive Ventilation vs. Sham Ventilation in Survivors of Acute Hypercapnic Respiratory Failure in Chronic Obstructive Airway Disease
Dr Cheung Pik Shan
Department of Medicine, United Christian Hospital
Background
COPD patients who survive an episode of acute hypercapnic respiratory failure (AHRF) after treatment with non-invasive ventilation (NIV) have high risk of recurrent AHRF. We hypothesize that continuation of NIV at home would reduce the likelihood of recurrent AHRF.
Method
This was a prospective, single-centre, randomized, single-blind controlled study comparing continuation of NIV (BiPAP SynchronyTM, Respironics INC., Murrysville, PA, USA.) at home vs. sham ventilation in COPD patients who survived after an episode of AHRF treated with acute NIV. Patients with significant OSA, non-COPD causes of AHRF, adverse psycho-social circumstances and serious co-morbidities were excluded. The primary end-point was time-to-recurrent AHRF requiring acute NIV or intubation or resulting in death.
Results
Our unit has treated 235 patients presented with AHRF with NIV during the study period. 156 patients were excluded (non-COPD cause of respiratory failure 74, significant OSA 18, on home NIV before admission 17, refused NIV treatment 17, unfavourable psychosocial factor 9, serious co-morbidities 16, miscellaneous 5). 79 patients met the inclusion criteria and 47 patients were successfully randomised. Most patients were males (43 males, 4 females), with a mean age of 70.3 ± 7.7 years. The mean FEV1 30.0 ± 9.0 % predicted and mean PaCO2 on admission was 10.5 ± 3.0 kPa. There was no significant difference in the demographics between the two study groups. 23 patients were randomized to home NIV group with a mean IPAP of 14.8 ± 1.1 cmH20 while 24 patients received sham home ventilation (CPAP 5 cmH2O). At 180 days, there was a significant reduction of recurrent AHRF in the home NIV group (23.2%) vs. sham ventilation (57.5%) (p = 0.035, log-rank test).
Conclusion
In COPD patients with AHRF treated by acute NIV, continuation with home NIV is associated with a lower risk of recurrent AHRF when compared with sham ventilation.
