Survival of Hypercapnic Patients with COPD and Obesity Hypoventilation Syndrome Treated with High Intensity Non Invasive Ventilation in the Daily Routine Care



Thomas Blankenburg1, *, Christin Benthin1, Stefanie Pohl1, Anett Bramer1, Frank Kalbitz2, Christine Lautenschläger3, Wolfgang Schütte1
1 2nd Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
2 1st Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
3 Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, D-06112 Halle, Germany


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© 2017 Blankenburg et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the 2nd Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany, Tel: +493455591144; Fax: +493455591442; E-mails: th.blankenburg@martha-maria.de, th.blankenburg@gmx.de


Abstract

Background:

Home ventilation is an effective treatment option for obesity hypoventilation syndrome (OHS). This therapy is still controversial for stable chronic obstructive pulmonary disease (COPD). A recent study showed reduced mortality for COPD patients receiving home ventilation with high inflation pressures and back-up respiratory rates [so called High Intensity non-invasive ventilation (NIV)].

Objective:

The purpose of this study is whether High Intensity NIV applied in the routine care of COPD and OHS patients can lead to CO2 reduction and survival data comparable to data from controlled studies.

Method:

In this prospective non interventional study fifty-one patients with COPD (FEV1 0.95l, corr. 32.8%) and 34 patients with OHS (VC 1.74l, corr. 50.7%) with chronic hypercapnic respiratory failure, who were treated with NIV were followed up for four years.

Results:

Elevated CO2 values before NIV in COPD patients (8.6kPa), and in OHS patients (8.3kPa), could be lowered significantly to the upper normal range (COPD: 5.9kPa; OHS: 5.85kPa). The one-, two-, and three-year survival rates for COPD patients were 83%, 73%, and 55%, respectively. The one-, two-, and three-year survival rates for OHS patients were 85%, 72%, and 68%, respectively.

Conclusion:

High intensity NIV within routine care is effective in reducing blood CO2 levels in COPD- and in OHS- related chronic respiratory insufficiency. The survival rates obtained here are comparable to data from controlled clinical trials on COPD.

Keywords: Chronic Obstructive Pulmonary Disease, Non-invasive ventilation, Routine care, Hypercapnia, Ventilatory insufficiency, Prognosis, Home ventilation, Routine care.