Evolution of the Use of Noninvasive Mechanical Ventilation in Chronic Obstructive Pulmonary disease

Abstract

Introduction: Chronic non-invasive ventilation (NIV) is effective in COPD patients with chronic hypercapnic respiratory failure. The aim of this study was to evaluated the effect of domiciliary NIV in COPD patients under home NIV

Methods: We carried out a retrospective study between 2015 and 2021 of COPD patients under long-term NIV at Pneumology departement D, Abderrahmen Mami hospital. Study participants were reassessed in the 3th and 12th months after the initial evaluation

Results: There were 70 patients with an average age of 65.7 years and a sex ratio (M/F) of 4.3. All patients were smokers. Mean age of initiation smoking was 21 years. Mean body mass index was 26Kg/m2. The mean pack-years of smoking was 56. The most common comorbidities were sleep apnea syndrome (17%), Bronchiectasis (8.6%) and lung cancer (4.3%). A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a decline in of the mean rates for annual hospital admissions in the first year (1.2 per year vs 1.04, p<0.01) and intensive care unit hospitalizations (0.33 vs 0.11, p<0.01). There was a significant improvement in COPD exacerbations (The average rate of exacerbation was 2.2/year became 1/year, p<0.001), FEV1 (0.88L vs 099L, p<0.01), PO2 (51.5 vs 54.8, p<0.001) and PCO2 (62 vs 58.3, p<0.001) in 3 months of follow-up.

Conclusions: Our study showed that home NIV contributes to the stabilization of some COPD patients by reducing the rates of hospitalization for exacerbation.