A prospective observational study on long-term non invasive ventilation (L-T NIV) in COPD patients attending an inpatient pulmonary rehabilitation program (PRP)

The onset of L-T NIV is often considered for patients with hypercapnic respiratory failure (HRF) due to COPD during an inpatient PRP. But despite the success of NIV in treating acute COPD exacerbations, its long-term use in stable COPD is still debated. Aims: To investigate reasons for starting L-T NIV and its subsequent effects in COPD patients admitted to an inpatient PRP. Methods: Ongoing, multicentric, observational study of patients with HRF due to COPD adapted to L-T NIV during an inpatient PRP. At the time of the onset patients with alternative causes of HRF are excluded and clinical data, pulmonary function test, blood gases, sleep study and functional evaluation are collected. Preliminary Results refer to enrollment period (April 2017-December 2017):54 consecutive COPD patients were enrolled. 33 of them (mean [SD] age 73 [7,87] years, BMI of 24,55 [4,62], FEV1 34,09 % [6,36], pH 7,358[0.045], PaCO2 61 mmHg [8,41]) were eligible. 13 patients started L-T NIV for recurrent exacerbations of HRF requiring NIV; 12 for failed weaning from in hospital NIV; 4 for stable hypercapnia (PaCO2 > 55 mmHg); 3 after weaning from invasive mechanical ventilation. The mean ventilator settings were an inspiratory airway pressure of 17,7 [2,59]cmH2O, an expiratory positive airway pressure of 6,35[1,3]cmH2O and a backup rate of 12,06 [1,7] bpm. At the end of PRP patients showed a mean PH 7,405 [0,02] and mean PaCO2 51,10 mmHg [6,76]. Conclusions: Among COPD patients with HRF attending an inpatient PRP, recurrent exacerbation requiring NIV and failed weaning from hospital NIV were the most frequent reasons for starting L-T NIV.