NIV in COPD with chronic hypercapnia
Trial question
What is the effect of home noninvasive ventilation plus oxygen therapy in patients with persistent hypercapnia after an acute COPD exacerbation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
53.0% female
47.0% male
N = 116
116 patients (61 female, 55 male).
Inclusion criteria: patients with persistent hypercapnia (PaCO2 > 53 mmHg) who had an acute COPD exacerbation.
Key exclusion criteria: obesity (BMI > 35), obstructive sleep apnea syndrome, or other causes of respiratory failure.
Interventions
N=57 home noninvasive ventilation plus oxygen therapy (ventilator setting are inspiratory positive airway pressure of 24 cmH₂O, an EPAP of 4 cmH₂O, and a backup rate of 14 breaths/minute plus median oxygen flow rate of 1.0 L/min).
N=59 home oxygen therapy alone (median oxygen flow rate, 1.0 L/min).
Primary outcome
Time to readmission or death within 12 months
4.3 months
1.4 months
4.3 months
3.2 months
2.1 months
1.1 months
0.0 months
Home noninvasive ventilation plus oxygen
therapy
Home oxygen therapy
alone
Significant
increase ▲
Significantly longer time to readmission or death within 12 months (4.3 months vs. 1.4 months).
Secondary outcomes
No significant difference in readmission or death at 12 months (63.4% vs. 80.4%; ARR 17, 95% CI 0.1 to 34).
Conclusion
In patients with persistent hypercapnia (PaCO2 > 53 mmHg) who had an acute COPD exacerbation, home noninvasive ventilation plus oxygen therapy was superior to home oxygen therapy alone with respect to time to readmission or death within 12 months.
Reference
Murphy PB, Rehal S, Arbane G et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA. 2017 Jun 6;317(21):2177-2186.
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