RT Journal Article
SR Electronic
T1 Evolving use of long-term NIV in COPD: Are we getting it right
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2475
VO 42
IS Suppl 57
A1 Anne Pocock
A1 Mark Ambrose
A1 Karen Ward
A1 Bis Chakrabarti
A1 Nick Duffy
A1 John O'Reilly
A1 Robert Parker
A1 Julie Cheney
A1 Robert Angus
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P2475.abstract
AB BackgroundThe use of long-term NIV in COPD continues to be a controversial subject. Longer term trials show questionable benefit but there is debate over methodology such as the adequacy of ventilation and patient selection in the studies. We serve a population of 2.7 million offering a tertiary service with around 130 patients being established annually on NIV. Previously we observed that less than 5 percent of patients commenced on NIV had COPD.MethodsWe have reviewed the NIV set ups for 2011/12 to examine current practice, referral patterns and outcomes of the use of NIV in COPD.Results72 of 262 (27.48%) of patients established had COPD; 34 (47%) men with a mean(SD)age 65 (7.6) years. 4 categories of indication were noted: overlap mainly with OSA and obesity 38 (53%) of patients, to allow weaning off tracheostomy ventilation post exacerbation 7(10%), oxygen sensitivity and or decompensating ventilatory failure without exacerbations 17(24%) and recurrent admissions with decompensated type 2 respiratory failure 10(14%). Referral from our catchment area hospitals ranged from 3-14, those with a sleep screening service sending more. 13/72 (18.05%) of patients died, the mean time to death at date of review was 9.19 months, 4/72 (6%) patients complied poorly and chose to return device, 33/72 patients (45.8%) of the patients had no readmissions.ConclusionThe use of long-term NIV has increased considerably in the last 10 years and is now accounts for a quarter of new start ups. For our service overlap syndromes and oxygen sensitivity are main indication for the use of longterm NIV in these COPD patients. There remains a need for work to define the optimal use of NIV long-term in COPD.