Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation
To assess the prevalence and the impact of chronic and/or acute non-respiratory co-morbidity on short and longer-term outcome of non-invasive positive pressure ventilation (NIPPV) in acute decompensations of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF).
Design and setting
An observational study in a three-bed respiratory monitoring unit in a respiratory ward of a non-university hospital.
We grouped 120 consecutive COPD patients requiring NIPPV for AHRF (pH 7.28±0.05, PaO2/FIO2 ratio 192±63, PaCO2 78.3±12.3 mmHg) according to whether NIPPV succeeded (n=98) or failed (n=22) in avoiding the need for endotracheal intubation and whether alive (n=77) or dead (n=42) at 6 months.
Measurements and results
The prevalence of chronic and acute co-morbidity was, respectively, 20% and 41.7%; most of the cases were cardiovascular. In-hospital NIPPV failure was greater in patients with than in those without chronic (33.3% vs. 14.6%) or acute co-morbidity (32% vs. 8.6%). Six-month mortality was worse in patients with than in those without chronic (54.2% vs. 30.5%) or more than one acute co-morbidity (66.7% vs. 30.8%). Multiple regression analysis predicted in-hospital NIPPV failure by acute co-morbidity and forced expiratory volume in 1 s, while death at 6 months was predicted by having more than one acute co-morbidity, non-cardiovascular chronic co-morbidity and Activities of Daily Living score.
Chronic and acute co-morbidities are common in COPD patients with AHRF needing NIPPV and their presence influences short and longer-term outcome.
KeywordsCo-morbidities Chronic obstructive pulmonary disease Acute hypercapnic respiratory failure Non-invasive positive pressure ventilation Charlson index
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