Heinemann, Frank and Budweiser, Stephan and Joerres, Rudolf A. and Arzt, Michael and Roesch, Florian and Kollert, Florian and Pfeifer, Michael (2011) The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning. RESPIROLOGY, 16 (8). pp. 1273-1280. ISSN 1323-7799,
Full text not available from this repository. (Request a copy)Abstract
Background and objective: Patients with COPD who require prolonged weaning from invasive mechanical ventilation show poor long-term survival. Whether non-invasive home mechanical ventilation (HMV) has a beneficial effect after prolonged weaning has not yet been clearly determined. Methods: Patients with COPD who required prolonged weaning and were admitted to a specialized weaning centre between January 2002 and February 2008 were enrolled in the study. Long-term survival and prognostic factors, including the role of non-invasive HMV, were evaluated. Results: Of 117 patients (87 men, 30 women; mean age 69.5 +/- 9.5 years) included in the study, weaning from invasive ventilation was achieved in 82 patients (70.1%). Successful weaning was associated with better survival 1 year after discharge from hospital (hazard ratio (HR) 2.24, 95% CI: 1.16-4.31; P = 0.016). Among the 82 patients who were successfully weaned, non-invasive HMV was initiated in 39 (47.6%) due to persistent chronic ventilatory failure. Initiation of HMV was associated with a higher rate of survival to 1 year as compared with patients who did not receive ventilatory support (84.2% vs 54.3%; HR 3.68, 95% CI: 1.43-9.43; P = 0.007). In addition, younger age and higher PaO(2), haemoglobin concentration and haematocrit at discharge were associated with better survival. In an adjusted multivariate analysis, initiation of non-invasive HMV after successful weaning remained an independent prognostic factor for survival to 1 year (HR 3.63, 95% CI: 1.23-10.75; P = 0.019). Conclusions: These findings suggest that based on the potential for improvement in long-term survival, non-invasive HMV should be considered in patients with severe COPD and persistent chronic hypercapnic respiratory failure after prolonged weaning.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | POSITIVE-PRESSURE VENTILATION; ACUTE RESPIRATORY-FAILURE; STABLE HYPERCAPNIC COPD; LONG-TERM SURVIVAL; CONSENSUS CONFERENCE; CONTROLLED-TRIAL; EXACERBATIONS; MULTICENTER; MANAGEMENT; REDUCTION; chronic obstructive pulmonary disease; home mechanical ventilation; non-invasive positive pressure ventilation; respiratory failure; weaning |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 27 May 2020 15:20 |
| Last Modified: | 27 May 2020 15:20 |
| URI: | https://pred.uni-regensburg.de/id/eprint/19921 |
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