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2012

2012 June - A Randomised Controlled Trial Comparing Stepwise versus Immediate Withdrawal from Non-Invasive Ventilation in Chronic Obstructive Pulmonary Disease Patients Recovering from Acute Hypercapnic Respiratory Failure

Dr. Chung-Tat LUN; Department of Medicine, United Christian Hospital

Background
COPD patients who suffer from exacerbation with acute hypercapnic respiratory failure (AHcRF) benefit from non-invasive ventilation (NIV). The best withdrawal method of NIV is however not known. We designed a study comparing stepwise withdrawal versus immediate withdrawal of NIV to assess the success rate of withdrawal of NIV after recovery of AHcRF.

Method
This was a prospective, single-centre, open-labelled randomised study comparing stepwise withdrawal of NIV and immediate withdrawal of NIV in patients with COPD exacerbation recovering from AHcRF. The primary end-point was the success rate of NIV withdrawal.

Results
Sixty patients were randomised: 35 patients to the stepwise withdrawal group and 25 patients to the immediate withdrawal group. Six patients in the stepwise withdrawal group were withdrawn after randomisation (5 withdrew consent and 1 patient had concurrent metabolic acidosis). The two study arms were well balanced demographically. There was no statistically significant difference in the success rate of withdrawal of NIV and length of stay after randomisation, with the success rate of 74.3% and 56% in stepwise and immediate withdrawal group respectively (p = 0.139). There was statistically significant difference in the duration of NIV with median duration of 5 days and 3 days in stepwise and immediate withdrawal group respectively (p = 0.001).

Conclusion
Our study showed no statistically significant difference in the success rate and length of stay between stepwise withdrawal and immediate withdrawal of NIV. Duration of NIV was statistically significant shorter in the immediate withdrawal group.

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