Investigation of COPD patients discharged without home mechanical ventilation after in-hospital use of acute non-invasive ventilation

Abstract

In stable hypercapnic chronic obstructive pulmonary disease (COPD) patients, clear benefits have been shown on long-term non-invasive positive pressure ventilation (NPPV) use, targeting reduction of hypercapnia. In contrast, the effectiveness of continuing NPPV at home after acute NPPV during hospitalization is controversial. To evaluate the prognosis and clinical course of patients with COPD who used acute NPPV during hospitalization but not after discharge, we conducted a retrospective, single-center, chart review on patients admitted because of an acute exacerbation of COPD, who used NPPV during hospitalization between December 2010 and March 2014. Of 50 patients, 25 patients were excluded due to insufficient follow-up and death during hospitalization. 18 patients continued using NPPV after discharge, while 7 patients did not. The average PaCO₂ on discharge was 62.0 mmHg in patients who used NPPV after discharge and 51.2 mmHg in patients who did not. Percentage of patients who developed an exacerbation after discharge was 61.0% and 42.9%, respectively. Median survival, event-free survival, and rate of acute exacerbation between the two groups were not significantly different. PaCO₂-matched comparison revealed no significant difference in median survival and event-free survival between the patients with NPPV and without NPPV after discharge. PaCO₂ before discharge or NPPV usage after discharge was not related to the acute exacerbation after discharge. COPD patients treated with acute NPPV in hospital did not continue NPPV after discharge when PaCO₂ got lower. In these patients prognosis was not significantly different from those with chronic NPPV. The doctors’ judgment of discontinuing NPPV when PaCO₂ has improved in hospital is feasible for COPD patients.