期刊報告 2012-02-李淑鈴

The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning

Rresp_2054 1273..1280
FRANK HEINEMANN, STEPHAN BUDWEISER, RUDOLF A. JÖRRES, MICHAEL ARZT,
FLORIAN RÖSCH, FLORIAN KOLLERT AND MICHAEL PFEIFER


ABSTRACT
Background and objective: Patients with COPD who require prolonged weaning from invasive mechanical
ventilation show poor long-term survival. Whether non-invasive home mechanical ventilation (HMV) has
a beneficial effect after prolonged weaning has not yet been clearly determined. Methods: Patients with COPD who required prolonged weaning and were admitted to a specialized weaning centre between January 2002 and February 2008 were enrolled in the study. Long-term survival and prognostic factors, including the role of noninvasive HMV, were evaluated.

Results: Of 117 patients (87 men, 30 women; mean age 69.5 9.5 years) included in the study, weaning from invasive ventilation was achieved in 82 patients (70.1%). Successful weaning was associated with better survival 1 year after discharge from hospital (hazard ratio (HR) 2.24, 95% CI: 1.16–4.31; P = 0.016). Among the 82 patients who were successfully weaned, noninvasive HMV was initiated in 39 (47.6%) due to persistent chronic ventilatory failure. Initiation of HMV was associated with a higher rate of survival to 1 year as compared with patients who did not receive ventilatory support (84.2% vs 54.3%; HR 3.68, 95% CI: 1.43–9.43; P = 0.007). In addition, younger age and higher PaO2, haemoglobin concentration and haematocrit at discharge were associated with better survival. In an adjusted multivariate analysis, initiation of noninvasive HMV after successful weaning remained an independent prognostic factor for survival to 1 year (HR 3.63, 95% CI: 1.23–10.75; P = 0.019).


Conclusions: These findings suggest that based on the potential for improvement in long-term survival, non-invasive HMV should be considered in patients with severe COPD and persistent chronic hypercapnic
respiratory failure after prolonged weaning.

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1843.2011.02054.x/pdf