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Soleimani F, Donker DW, Oppersma E, Duiverman ML. Clinical evidence and technical aspects of innovative technology and monitoring of chronic NIV in COPD: a narrative review. Expert Rev Respir Med 2024; 18:513-526. [PMID: 39138642 DOI: 10.1080/17476348.2024.2384024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Chronic nocturnal noninvasive ventilation (NIV) improves outcomes in COPD patients with chronic hypercapnic respiratory failure. The aim of chronic NIV in COPD is to control chronic hypercapnic respiratory insufficiency and reduce symptoms of nocturnal hypoventilation, thereby improving quality of life. Chronic NIV care is more and more offered exclusively at home, enabling promising outcomes in terms of patient and caregiver satisfaction, hospital care consumption and cost reduction. Yet, to achieve and maintain optimal ventilation, during adaptation and follow-up, effective feasible (home) monitoring poses a significant challenge. AREAS COVERED Comprehensive monitoring of COPD patients receiving chronic NIV requires integrating data from ventilators and assessment of the patient's status including gas exchange, sleep quality, and patient-reported outcomes. The present article describes the physiological background of monitoring during NIV and aims to provide an overview of existing methods for monitoring, assessing their reliability and clinical relevance. EXPERT OPINION Patients on chronic NIV are 'ideal' candidates for home monitoring; the advantages of transforming hospital to home care are huge for patients and caregivers and for healthcare systems facing increasing patient numbers. Despite the multitude of available monitoring methods, identifying and characterizing the most relevant parameters associated with optimal patient well-being remains unclear.
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Affiliation(s)
- F Soleimani
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - D W Donker
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
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Seijger CGW, Vosse BAH, la Fontaine L, Raveling T, Cobben NAM, Wijkstra PJ. Validity and reliability of the Dutch version of the S3-NIV questionnaire to evaluate long-term noninvasive ventilation. Chron Respir Dis 2024; 21:14799731241236741. [PMID: 38420967 PMCID: PMC10906045 DOI: 10.1177/14799731241236741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Noninvasive ventilation (NIV) is an effective treatment for chronic respiratory failure (CRF). Patient-centered outcomes need to be evaluated regularly and the S3-NIV questionnaire seems an applicable tool. We translated this short, self-administered questionnaire into a Dutch version and tested its construct validity and reliability. METHODS An observational study was conducted, including 127 stable long-term NIV users with CRF or complex sleep related breathing disorders due to different underlying diseases: chronic obstructive pulmonary disease (25%), slowly progressive neuromuscular disorders (35%), rapidly progressive neuromuscular disorders (12%) and 'other disorders' (28%) including complex sleep apnea and obesity hypoventilation syndrome. Construct validity and reliability were tested. RESULTS The Dutch version of the questionnaire was obtained after a translation and back-translation process. Internal consistency of the total score was good (Cronbach's α coefficient of 0.78) as well as for the 'respiratory symptoms' subdomain and the 'sleep and side effects' subdomain (Cronbach's α coefficient of 0.78 and 0.69, respectively). The reproducibility was excellent with an intraclass correlation of 0.89 (95% CI 0.87-0.93). Construct validity was good for the 'respiratory symptoms' subdomain. CONCLUSION The Dutch S3-NIV questionnaire is a reliable and valid tool to evaluate symptoms, sleep, and NIV related side effects in long-term NIV users.
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Affiliation(s)
- Charlotte GW Seijger
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bettine AH Vosse
- Department of Pulmonary Diseases and Home Mechanical Ventilation, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Leandre la Fontaine
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Tim Raveling
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nicolle AM Cobben
- Department of Pulmonary Diseases and Home Mechanical Ventilation, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Raveling T, Rantala HA, Duiverman ML. Home ventilation for patients with end-stage chronic obstructive pulmonary disease. Curr Opin Support Palliat Care 2023; 17:277-282. [PMID: 37646583 PMCID: PMC10597445 DOI: 10.1097/spc.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF THE REVIEW The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this review, the authors summarize the evidence for nocturnal NIV and NIV during exercise. The authors discuss the multidisciplinary and advanced care of patients with end-stage COPD treated with NIV. RECENT FINDINGS Nocturnal NIV improves gas exchange, health-related quality of life and survival in stable hypercapnic COPD patients. Improvements in care delivery have been achieved by relocating care from the hospital to home based; home initiation of chronic NIV is feasible, non-inferior regarding efficacy and cost-effective compared to in-hospital initiation. However, the effect of NIV on symptoms is variable, and applying optimal NIV for end-stage COPD is complex. While exercise-induced dyspnoea is a prominent complaint in end-stage COPD, nocturnal NIV will not change this. However, NIV applied solely during exercise might improve exercise tolerance and dyspnoea. While chronic NIV is often a long-standing treatment, patient expectations should be discussed early and be managed continuously during the treatment. Further, integration of advance care planning requires a multidisciplinary approach. SUMMARY Although chronic NIV is an effective treatment in end-stage COPD with persistent hypercapnia, there are still important questions that need to be answered to improve care of these severely ill patients.
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Affiliation(s)
- Tim Raveling
- Department of Pulmonary Diseases and Home Mechanical Ventilation
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heidi A. Rantala
- Department of Respiratory Medicine
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marieke L. Duiverman
- Department of Pulmonary Diseases and Home Mechanical Ventilation
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Heunks L, Duiverman ML. New insights into acute and chronic respiratory failure: highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022. Eur Respir Rev 2023; 32:230027. [PMID: 37019460 PMCID: PMC10074168 DOI: 10.1183/16000617.0027-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 04/07/2023] Open
Abstract
The European Respiratory Society (ERS) is home to clinicians, scientists and students interested in respiratory medicine. In June 2022, the Society organised the second edition of the “Respiratory Failure and Mechanical Ventilation Conference”. This event focuses on clinical and scientific aspects of acute and chronic respiratory failure. Faculty and participants from 50 countries around the globe met in Berlin, although this time most of the sessions could also be accessed online. Participants with very diverse backgrounds, including medicine, nursing, physiotherapy and industry, discussed all aspects of respiratory failure including physiology, interventions for respiratory support, advanced diagnostic techniques, quality of life, and end of life care. Our common ground was passion for respiratory failure. The quality of the sessions during this 3-day conference was outstanding, and many of the presentations are still available for conference participants through the ERS website. However, the conference organisers felt that many of the topics discussed deserved an even broader audience. Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022 https://bit.ly/3HMWKTp
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Affiliation(s)
- Leo Heunks
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marieke L Duiverman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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BERES E, BABES K, BERES ZL, DAINA LG, DAINA CM, CHEREGI C, CIUMARNEAN L, DOGARU G. Cost-effectiveness of home non-invasive ventilation in COPD group GOLD D patients. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, estimated to be the third most common cause of death by 2020. The natural evolution of the disease is characterized by frequent exacerbations, severe exacerbations evolving with respiratory acidosis. Introducing home non-invasive ventilation (NIV) in the management of COPD group GOLD (Global Initiative for Chronic Obstructive Lung Disease) D patients generates supplementary costs, but the decreasing of the number of severe exacerbations will decrease the costs of drug treatment and hospitalization. This balance can be verified through a careful study of cost-effectiveness through modern methods of assessing the costs and years of life gained in relation to quality of life.
Material and method. This prospective study took place in the Emergency Department of the Bihor County Clinical Emergency Hospital, Oradea, between 01 October 2017 – 31 October2018, with a follow-up period of 2 years. We included 36 Group risk D COPD patients, presented with severe exacerbation that required NIV; the patients were divided into two study groups according to the treatment scheme after discharge (standard medication according to GOLD guidelines and long-term oxygen therapy - LTOT vs. LTOT + NIV). We follow-up at 2 years with the study group, and analyze the following: number of exacerbations (moderate and severe), number of hospitalizations, mortality rate in two years, average costs for the treatment of exacerbations and for stable COPD periods, quality adjusted life year (QALY).
Results and discussions. From 36 enrolled, 10 patients benefited from home NIV. The number of exacerbations was significantly lower in the NIV group compared with the LTOT group (1.72±0.79 vs 3.54±1.18). The incremental cost-effectiveness ratio (ICER) showed a net gain of 31% from gross product (GDP) per capita (5,641.71 ± 1,737.0-euro vs 9,272.3 ± 3,681.9 euro) per quality adjusted life year (QALY) for each patient.
Conclusions. Introduction home-NIV demonstrated clinical improvement and higher cost-effectiveness over LTOT alone in Class Risk D, COPD patients after discharge following a severe exacerbation.
Keywords: chronic obstructive pulmonary disease, non-invasive ventilation, cost-effectiveness, quality adjusted life year,
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Affiliation(s)
- Enikő BERES
- Cardiology Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Katalin BABES
- Cardiology Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | | | - Lucia Georgeta DAINA
- Psycho-neurosciences and Recovery Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Cristian Marius DAINA
- Psycho-neurosciences and Recovery Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Cornel CHEREGI
- Surgery Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Lorena CIUMARNEAN
- Internal Medicine Department, University of Medicine and Pharmacy „Iuliu Hatieganu”Cluj Napoca, Romania
| | - Gabriela DOGARU
- Medical Rehabilitation Department, University of Medicine and Pharmacy „Iuliu Hatieganu”Cluj Napoca, Romania
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Deng N, Sheng L, Jiang W, Hao Y, Wei S, Wang B, Duan H, Chen J. A home-based pulmonary rehabilitation mHealth system to enhance the exercise capacity of patients with COPD: development and evaluation. BMC Med Inform Decis Mak 2021; 21:325. [PMID: 34809614 PMCID: PMC8607968 DOI: 10.1186/s12911-021-01694-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a lifestyle which is long-term physically active. This study aimed to develop a home-based rehabilitation mHealth system incorporating behavior change techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility. METHODS Guided by the medical research council (MRC) framework the process of this study was divided into four steps. In the first step, the prescription was constructed. The second step was to formulate specific intervention functions based on the behavior change wheel theory. Subsequently, in the third step we conducted iterative system development. And in the last step two pilot studies were performed, the first was for the improvement of system functions and the second was to explore potential clinical benefits and validate the acceptance and usability of the system. RESULTS A total of 17 participants were enrolled, among them 12 COPD participants completed the 12-week study. For the clinical outcomes, Six-Minute Walk Test (6MWT) showed significant difference (P = .023) over time with an improvement exceeded the minimal clinically important difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P = .031) with a greater decrease of - 3. The mMRC levels reduced overall and showed significant difference. The overall compliance of this study reached 82.20% (± 1.68%). The results of questionnaire and interviews indicated good technology acceptance and functional usability. The participants were satisfied with the mHealth-based intervention. CONCLUSIONS This study developed a home-based PR mHealth system for COPD patients. We showed that the home-based PR mHealth system incorporating BCTs is a feasible and acceptable intervention for COPD patients, and COPD patients can benefit from the intervention delivered by the system. The proposed system played an important auxiliary role in offering exercise prescription according to the characteristics of patients. It provided means and tools for further individuation of exercise prescription in the future.
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Affiliation(s)
- Ning Deng
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Hangzhou, China
| | - Leiyi Sheng
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Wangshu Jiang
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Yongfa Hao
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Shuoshuo Wei
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Bei Wang
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Huilong Duan
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Juan Chen
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
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Raveling T, Vonk J, Struik FM, Goldstein R, Kerstjens HA, Wijkstra PJ, Duiverman ML. Chronic non-invasive ventilation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2021; 8:CD002878. [PMID: 34368950 PMCID: PMC8407093 DOI: 10.1002/14651858.cd002878.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic non-invasive ventilation (NIV) is increasingly being used to treat people with COPD who have respiratory failure, but the evidence supporting this treatment has been conflicting. OBJECTIVES To assess the effects of chronic non-invasive ventilation at home via a facial mask in people with COPD, using a pooled analysis of IPD and meta-analysis. SEARCH METHODS We searched the Cochrane Airways Register of Trials, MEDLINE, Embase, PsycINFO, CINAHL, AMED, proceedings of respiratory conferences, clinical trial registries and bibliographies of relevant studies. We conducted the latest search on 21 December 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing chronic NIV for at least five hours per night for three consecutive weeks or more (in addition to standard care) versus standard care alone, in people with COPD. Studies investigating people initiated on NIV in a stable phase and studies investigating NIV commenced after a severe COPD exacerbation were eligible, but we reported and analysed them separately. The primary outcomes were arterial blood gases, health-related quality of life (HRQL), exercise capacity (stable COPD) and admission-free survival (post-exacerbation COPD). Secondary outcomes for both populations were: lung function, COPD exacerbations and admissions, and all-cause mortality. For stable COPD, we also reported respiratory muscle strength, dyspnoea and sleep efficiency. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. After inclusion of a study, we requested the IPD. We analysed continuous and time-to-event data using linear- and cox-regression mixed-effect models with a random effect on study level. We analysed dichotomous IPD using generalised estimating equations. We adjusted all models for age and sex. We assessed changes in outcomes after three and 12 months. We also conducted a meta-analysis on aggregated trial data. MAIN RESULTS We included 14 new RCTs in this review update, in addition to the seven previously included. Seventeen studies investigated chronic NIV in stable COPD and four studies investigated chronic NIV commenced after a severe COPD exacerbation. Three studies compared NIV to sham continuous positive airway pressure (2 to 4 cmH2O). Seven studies used a nasal mask, one study used an oronasal mask and eight studies used both interfaces. Five studies did not report the interface. The majority of trials (20/21) were at high risk of performance bias due to an unblinded design. We considered 11 studies to have a low risk of selection bias and 13 to have a low risk of attrition bias. We collected and analysed the IPD from 13 stable COPD studies (n = 778, 68% of the participants included) and from three post-exacerbation studies (n = 364, 96% of the participants included). In the stable COPD group, NIV probably results in a minor benefit on the arterial partial pressure of oxygen (PaO2) after three months (adjusted mean difference (AMD) 0.27 kPa, 95% CI 0.04 to 0.49; 9 studies, 271 participants; moderate-certainty evidence), but there was little to no benefit at 12 months (AMD 0.09 kPa, 95% CI -0.23 to 0.42; 3 studies, 171 participants; low-certainty evidence). The arterial partial pressure of carbon dioxide (PaCO2) was reduced in participants allocated to NIV after three months (AMD -0.61 kPa, 95% CI -0.77 to -0.45; 11 studies, 475 participants; high-certainty evidence) and persisted up to 12 months (AMD -0.42 kPa, 95% CI -0.68 to -0.16; 4 studies, 232 participants; high-certainty evidence). Exercise capacity was measured with the 6-minute walking distance (minimal clinical important difference: 26 m). There was no clinically relevant effect of NIV on exercise capacity (3 months: AMD 15.5 m, 95% CI -0.8 to 31.7; 8 studies, 330 participants; low-certainty evidence; 12 months: AMD 26.4 m, 95% CI -7.6 to 60.5; 3 studies, 134 participants; very low-certainty evidence). HRQL was measured with the Severe Respiratory Insufficiency and the St. Georges's Respiratory Questionnaire and may be improved by NIV, but only after three months (3 months: standardised mean difference (SMD) 0.39, 95% CI 0.15 to 0.62; 5 studies, 259 participants; very low-certainty evidence; 12 months: SMD 0.15, 95% CI -0.13 to 0.43; 4 studies, 200 participants; very low-certainty evidence). Lastly, the risk for all-cause mortality is likely reduced by NIV (adjusted hazard ratio (AHR) 0.75, 95% CI 0.58 to 0.97; 3 studies, 405 participants; moderate-certainty evidence). In the post-exacerbation COPD group, there was little to no benefit on the PaO2 after three months, but there may be a slight decrease after 12 months (3 months: AMD -0.10 kPa, 95% CI -0.65 to 0.45; 3 studies, 234 participants; low-certainty evidence; 12 months: -0.27 kPa, 95% CI -0.86 to 0.32, 3 studies; 170 participants; low-certainty evidence). The PaCO2 was reduced by NIV at both three months (AMD -0.40 kPa, 95% CI -0.70 to -0.09; 3 studies, 241 participants; moderate-certainty evidence) and 12 months (AMD -0.52 kPa, 95% CI -0.87 to -0.18; 3 studies, 175 participants; high-certainty evidence). NIV may have little to no benefit on HRQL (3 months: SMD 0.25, 95% CI -0.01 to 0.51; 2 studies, 219 participants; very low-certainty evidence; 12 months: SMD 0.25, 95% -0.06 to 0.55; 2 studies, 164 participants; very low-certainty evidence). Admission-free survival seems improved with NIV (AHR 0.71, 95% CI 0.54 to 0.94; 2 studies, 317 participants; low-certainty evidence), but the risk for all-cause mortality does not seem to improve (AHR 0.97, 95% CI 0.74 to 1.28; 2 studies, 317 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Regardless of the timing of initiation, chronic NIV improves daytime hypercapnia. In addition, in stable COPD, survival seems to be improved and there might be a short term HRQL benefit. In people with persistent hypercapnia after a COPD exacerbation, chronic NIV might prolong admission-free survival without a beneficial effect on HRQL. In stable COPD, future RCTs comparing NIV to a control group receiving standard care might no longer be warranted, but research should focus on identifying participant characteristics that would define treatment success. Furthermore, the optimal timing for initiation of NIV after a severe COPD exacerbation is still unknown.
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Affiliation(s)
- Tim Raveling
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - Judith Vonk
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Fransien M Struik
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Roger Goldstein
- Division of Respiratory Medicine, West Park Healthcare Centre, University of Toronto, Toronto, Canada
| | - Huib Am Kerstjens
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - Marieke L Duiverman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
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Jolly G, Razakamanantsoa L, Fresnel E, Gharsallaoui Z, Cuvelier A, Patout M. Defining successful non-invasive ventilation initiation: Data from a real-life cohort. Respirology 2021; 26:1067-1075. [PMID: 34312942 DOI: 10.1111/resp.14118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/31/2021] [Accepted: 07/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE When home non-invasive ventilation (NIV) is initiated, five goals need to be achieved: a daily use >4 h/day, an improvement in gas exchange, health-related quality of life (HRQL) and sleep quality without side effects. Our aim was to assess how frequently these five goals were reached and the factors predictive of achievement. METHODS We conducted a monocentric cohort study that included patients electively established on home NIV over 2 years. HRQL was assessed at baseline and follow-up by the Severe Respiratory Insufficiency questionnaire. Adequate initiation was defined as the achievement of at least three of five goals and successful initiation as the achievement of all. RESULTS Two-hundred and fifty patients were included at baseline. NIV was initiated for: obesity hypoventilation syndrome (n = 95; 38%), neuromuscular disease (n = 70; 28%), chronic obstructive pulmonary disease (n = 66; 26%) and chest wall disease (n = 19; 8%). At follow-up, measures of all five goals were available in 141 (56%) patients. NIV initiation was adequate for 96 (68%) patients and successful for 12 (9%) patients. In multivariate analysis, a tidal volume ≥ 7.8 ml/kg of ideal body weight was associated with an increased likelihood of adequate NIV initiation (hazard ratio: 5.765 [95% CI:1.824-18.223], p = 0.006]. Improvement in daytime partial arterial carbon dioxide pressure (PaCO2 ) was not correlated to improvement in HRQL or sleep quality. Severe to very severe NIV-related side effects occurred in 114 (47%) patients and were associated with higher daytime PaCO2 (6.35 ± 1.08 vs. 5.92 ± 0.79 kPa, p < 0.001). CONCLUSION Successful home NIV initiation is rarely achieved in real life. HRQL and NIV tolerance should be assessed to improve patient-centred outcomes.
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Affiliation(s)
- Grégoire Jolly
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France
| | - Léa Razakamanantsoa
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France
| | | | - Zouhaier Gharsallaoui
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France
| | - Antoine Cuvelier
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France
| | - Maxime Patout
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France.,Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,URMS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
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Cantero C, Pasquina P, Dao MD, Cedraschi C, Adler D, Plojoux J, Janssens JP. Impact of Confinement in Patients under Long-Term Noninvasive Ventilation during the First Wave of the SARS-CoV-2 Pandemic: A Remarkable Resilience. Respiration 2021; 100:909-917. [PMID: 34130277 PMCID: PMC8339039 DOI: 10.1159/000516327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/22/2021] [Indexed: 01/13/2023] Open
Abstract
Background During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders. Objectives To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March–April 2020). Methods A questionnaire-based survey exploring mood disturbances (HAD), symptom scores related to NIV (S<sup>3</sup>-NIV), and perception of health-care providers during confinement was sent to all patients under LTHNIV followed up by our center. Symptom scores and data obtained by ventilator software were compared between confinement and the 56 days prior to confinement. Results Of a total of 100 eligible patients, 66 were included (median age: 66 years [IQR: 53–74]): 35 (53%) with restrictive lung disorders, 20 (30%) with OHS or SRBD, and 11 (17%) with COPD or overlap syndrome. Prevalence of anxiety (n = 7; 11%) and depressive (n = 2; 3%) disorders was remarkably low. Symptom scores were slightly higher during confinement although this difference was not clinically relevant. Technical data regarding ventilation, including compliance, did not change. Patients complained of isolation and lack of social contact. They felt supported by their relatives and caregivers but complained of the lack of regular contact and information by health-care professionals. Conclusions Patients under LTHNIV for CRF showed a remarkable resilience during the SARS-CoV-2 confinement period. Comments provided may be helpful for managing similar future health-care crises.
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Affiliation(s)
- Chloé Cantero
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Pasquina
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Division of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Cedraschi
- Division of General Medical Rehabilitation and Multidisciplinary Pain Center, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Plojoux
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
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10
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Majorski DS, Schwarz SB, Magnet FS, Ahmad R, Mathes T, Windisch W. The Severe Respiratory Insufficiency Application (SRI App): a pilot randomised controlled trial. Thorax 2021; 76:thoraxjnl-2020-216319. [PMID: 33653932 PMCID: PMC8311098 DOI: 10.1136/thoraxjnl-2020-216319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/08/2020] [Accepted: 01/31/2021] [Indexed: 11/04/2022]
Abstract
An application (app) for the Severe Respiratory Insufficiency Questionnaire (SRI) has been designed and developed for mobile devices. In a randomised controlled trial comprising 60 patients with chronic respiratory failure, the app was compared with the classic paper SRI. Thereby, it was shown that the SRI app is a practical tool that is well accepted. Missing values can be completely avoided by using the SRI app. Finally, reliability, convergent and discriminant validities were established. Accordingly, for the individual SRI subscales, Cronbach's alpha ranged between 0.56 and 0.81 (app) and between 0.54 and 0.83 (paper), respectively. The multilingual SRI app is accessible free of charge for non-profit research purposes.
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Affiliation(s)
| | | | | | - Rebar Ahmad
- Informatics, Hochschule Niederrhein, Krefeld, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, University Witten/Herdecke, Köln, Germany
| | - Wolfram Windisch
- Lung Clinic, Kliniken der Stadt Köln gGmbH, Köln, Germany
- Faculty of Health, Universität Witten/Herdecke, Witten, Germany
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11
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Majorski DS, Duiverman ML, Windisch W, Schwarz SB. Long-term noninvasive ventilation in COPD: current evidence and future directions. Expert Rev Respir Med 2021; 15:89-101. [PMID: 33245003 DOI: 10.1080/17476348.2021.1851601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Long-term noninvasive ventilation (NIV) is an established treatment for end-stage COPD patients suffering from chronic hypercapnic respiratory failure. This is reflected by its prominent position in national and international medical guidelines. Areas covered: In recent years, novel developments in technology such as auto-titrating machines and hybrid modes have emerged, and when combined with advances in information and communication technologies, these developments have served to improve the level of NIV-based care. Such progress has largely been instigated by the fact that healthcare systems are now confronted with an increase in the number of patients, which has led to the need for a change in current infrastructures. This article discusses the current practices and recent trends, and offers a glimpse into the future possibilities and requirements associated with this form of ventilation therapy. Expert opinion: Noninvasive ventilation is an established and increasingly used treatment option for patients with chronic hypercapnic COPD and those with persistent hypercapnia following acute hypercapnic lung failure. The main target is to augment alveolar hypoventilation by reducing PaCO2 to relieve symptoms. Nevertheless, when dealing with severely impaired patients, it appears necessary to switch the focus to patient-related outcomes such as health-related quality of life.
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Affiliation(s)
- Daniel S Majorski
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Sarah B Schwarz
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
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12
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Valko L, Baglyas S, Gyarmathy VA, Gal J, Lorx A. Home mechanical ventilation: quality of life patterns after six months of treatment. BMC Pulm Med 2020; 20:221. [PMID: 32807149 PMCID: PMC7433042 DOI: 10.1186/s12890-020-01262-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background It has been shown that home mechanical ventilation improves quality of life, but it has not been widely studied which particular patient groups benefit the most from starting this type of therapy. The purpose of this prospective observational study was to evaluate quality of life change patterns 6 months after initiation of home mechanical ventilation in patients suffering from chronic respiratory failure using patient reported outcomes. Methods We enrolled 74 chronic respiratory failure patients starting invasive or noninvasive home mechanical ventilation through the Semmelweis University Home Mechanical Ventilation Program. Quality of life was evaluated at baseline and at 6 months after initiation of home mechanical ventilation using the Severe Respiratory Insufficiency Questionnaire. Results Overall quality of life showed 10.5% improvement 6 months after initiation of home mechanical ventilation (p < 0.001). The greatest improvement was observed in Respiratory complaint (20.4%, p = 0.015), Sleep and attendant symptoms (19.3%, p < 0.001), and Anxiety related subscales (14.4%, p < 0.001). Interface (invasive versus noninvasive ventilation) was not associated with improvement in quality of life (p = 0.660). Severely impaired patients showed the greatest improvement (CC = -0.328, p < 0.001). Initial diagnosis contributed to the observed change (p = 0.025), with chronic obstructive pulmonary disease and obesity hypoventilation syndrome patients showing the greatest improvement, while amyotrophic lateral sclerosis patients showed no improvement in quality of life. We found that patients who were started on long term ventilation in an acute setting, required oxygen supplementation and had low baseline quality of life, showed the most improvement during the six-month study period. Conclusions Our study highlights the profound effect of home mechanical ventilation on quality of life in chronic respiratory failure patients that is indifferent of ventilation interface but is dependent on initial diagnosis and some baseline characteristics, like acute initiation, oxygen supplementation need and baseline quality of life. Trial registration This study was approved by and registered at the ethics committee of Semmelweis University (SE TUKEB 251/2017; 20th of December, 2017).
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Affiliation(s)
- Luca Valko
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary.
| | - Szabolcs Baglyas
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary
| | - V Anna Gyarmathy
- EpiConsult, Dover, DE, USA.,Johns Hopkins Bloomberg School of Public Health, Károly Racz School of PhD Studies, Semmelweis University, 8 the Green, STE A, Dover, DE, 19904, USA
| | - Janos Gal
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary
| | - Andras Lorx
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary
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13
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Zhou Z, Zhou A, Peng Y, Duan J, Zeng Y, Zhao Y, Cheng W, Chen P. Determinants of Clinical COPD Questionnaire in Patients with COPD: A Cross-Sectional Observational Study. Respiration 2020; 99:606-616. [PMID: 32659763 DOI: 10.1159/000507097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Clinical COPD Questionnaire (CCQ) has been suggested by the Global Initiative of Chronic Obstructive Lung Disease (GOLD) as a comprehensive symptom measurement tool, which helps to classify patients in order to direct pharmacological treatment. Therefore, it is essential to understand its determinants. OBJECTIVES To identify the determinants of the overall CCQ score and scores of its 3 subdomains among chronic obstructive pulmonary disease (COPD) patients from China. METHODS A total of 1,241 COPD patients in the outpatient department of the Second Xiangya Hospital in China were recruited. Basic information and clinical data were collected. Differences in the GOLD categories based on Modified Medical Research Council Dyspnea Scale (mMRC), COPD Assessment Test (CAT), and CCQ were compared. Multiple linear regression analyses were performed to evaluate determinant factors of the total CCQ and subdomain scores. RESULTS The total CCQ and/or separate domain scores significantly differed with sex, age, BMI, smoking status, biomass fuel exposure, exacerbation frequency, mMRC, CAT, and GOLD grades and groups. Subjects with asthma-COPD overlap (ACO) had worse health status based on CCQ than those with COPD alone. As for the 16 subgroups based on GOLD 2017, statistical differences in the total CCQ and functional domain scores were found among subgroups 1A-4A, 1B-4B, and 1D-4D. The mMRC classified much more patients into more symptom groups than CAT and CCQ. No significant difference was observed in the GOLD categories between the CAT and CCQ (cut point = 1.5). Multiple linear regression analysis showed that smoking status, underweight, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were independently associated with the total CCQ score. Only 3 variables were significantly associated with the symptom domain: ACO, exacerbations, and mMRC; for the functional domain, age ≥75 years, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were significant; female sex, underweight, frequent exacerbations (≥2), and mMRC were significantly associated with higher scores in the mental domain. CONCLUSIONS The classification of COPD produced by mMRC, CAT, and CCQ was not identical. Smoking status, underweight, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were associated with lower health-related quality of life assessed by the total CCQ score, while different subdomains of CCQ had different determinant factors.
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Affiliation(s)
- Zijing Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Aiyuan Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yating Peng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Jiaxi Duan
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yuqin Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yiyang Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Wei Cheng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China,
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14
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Valko L, Baglyas S, Kunos L, Terray-Horvath A, Lorx A, Gal J, Windisch W. Validation of the Hungarian version of the SRI Questionnaire. BMC Pulm Med 2020; 20:130. [PMID: 32380984 PMCID: PMC7204221 DOI: 10.1186/s12890-020-1171-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Home mechanical ventilation is a reliable treatment for patients suffering from chronic respiratory failure, improving survival and quality of life. Prevalence has been increasing worldwide as a result of evolving technical possibilities, telemedicine and improving national guidelines. Projects to establish a national guideline and registry for patients treated with home mechanical ventilation are currently under way in Hungary and our aim was to validate a quality of life questionnaire suited for evaluation and follow up in this specific patient group. The Severe Respiratory Insufficiency Questionnaire (SRI) is a quality of life tool designed to evaluate patients receiving home mechanical ventilation and has been validated both in patient groups receiving invasive and noninvasive ventilation. METHODS The Hungarian version of the SRI was created using the translation-backtranslation method, which was then tested for validity, viability and reliability in a cohort involving patients from three centers, receiving long-term home mechanical ventilation for chronic respiratory failure through an invasive or noninvasive interface. Patient data was collected (demographic data, lung function test, arterial blood gas, ventilation settings) and quality of life was measured with the previously validated SF-36 and newly created Hungarian SRI Questionnaires at two time points. RESULTS One hundred four patients receiving home mechanical ventilation were enrolled. The time to complete the SRI Questionnaire was 8.6 (±3.1) minutes, 69.2% questionnaires were self-administered. Exploratory factor analysis explained 73.8% of the variance of the questionnaire, but resulted in 13 scales. We found correlations between the SRI subscale scores to corresponding scales of the previously validated general quality of life survey SF-36. The Cronbach alpha coefficient was 0.928 for the Summary Scale of the SRI Questionnaire, proving high internal consistency. Reproducibility was high for most scales, resulting in a high overall correlation for the summary score (0.877, p < 0.001). CONCLUSIONS The Hungarian version of the SRI Questionnaire is a viable, valid, reliable and reproduceable quality of life tool applicable for patients treated with home mechanical ventilation.
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Affiliation(s)
- Luca Valko
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082 Hungary
| | - Szabolcs Baglyas
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082 Hungary
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Tomo utca 25-29, Budapest, 1083 Hungary
| | - Attila Terray-Horvath
- Department of Neurology, Hungarian Army Medical Center, Robert Karoly korut 44, Budapest, 1134 Hungary
| | - Andras Lorx
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082 Hungary
| | - Janos Gal
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082 Hungary
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109 Cologne, Germany
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15
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Kotanen P, Kainu A, Brander P, Bergman P, Lehtomäki A, Kreivi HR. Validation of the Finnish severe respiratory insufficiency questionnaire. CLINICAL RESPIRATORY JOURNAL 2020; 14:659-666. [PMID: 32155684 DOI: 10.1111/crj.13181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic respiratory insufficiency impacts patients' lives and reduces quality of life. The Severe Respiratory Insufficiency (SRI) questionnaire examines health-related quality of life and is designed specifically for patients receiving home mechanical ventilation (HMV) for chronic respiratory failure (CRF). OBJECTIVES The aim of this study was to validate the Finnish version of the SRI and study its reproducibility in patients with CRF. METHODS Our 74 patients receiving HMV or long-term oxygen treatment for CRF or both completed the SRI and St George's Respiratory questionnaires (SGRQ) three times (at baseline, and then one week and one month later). Reliability and validity of the questionnaires was analysed with Cronbach's alpha and intraclass correlation coefficient. Patients were prospectively followed up for 5 years, with data collected on their use of hospital services and mortality. RESULTS Cronbach's alpha in the SRI ranged from 0.67 to 0.88 and was >0.7 on all subscales except the "attendant symptoms and sleep". On four subscales, Cronbach's alpha was >0.8, and on the summary scale, 0.95. The SRI showed high correlation with SGRQ. Both tests showed good reproducibility. During the 5-year follow-up, 27 (36%) patients died. CONCLUSIONS The Finnish SRI proved valid, reliable and reproducible. Its psychometric properties were good and similar to those of the original questionnaire and of other validation studies.
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Affiliation(s)
- Petra Kotanen
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Annette Kainu
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland.,Terveystalo Healthcare, Digital Health, Helsinki, Finland
| | - Pirkko Brander
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paula Bergman
- Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Lehtomäki
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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16
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Smith TA, Ingham JM, Jenkins CR. Respiratory Failure, Noninvasive Ventilation, and Symptom Burden: An Observational Study. J Pain Symptom Manage 2019; 57:282-289.e1. [PMID: 30389607 DOI: 10.1016/j.jpainsymman.2018.10.505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is commonly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. We describe symptom burden in this population. MEASURES Fifty consecutive, consenting, English-speaking, cognitively intact patients, admitted to wards other than the intensive care unit in a tertiary teaching hospital and treated with NIV for hypercapnic respiratory failure, were recruited. The 14-item Condensed Memorial Symptom Assessment Scale was used to assess physical and psychological symptoms within 36 hours of commencing NIV. Breathlessness (using Borg score), pain location and intensity using a numerical rating scale, and four symptoms potentially prevalent in patients undergoing NIV (cough, sputum, gastric bloating, and dry eyes) were also assessed. OUTCOMES Patients reported a median of 10 symptoms (IQR 9-13). A median of five symptoms (IQR 3-7) were rated as severe. Breathlessness was the most prevalent and most distressing symptom, with participants reporting a mean maximum Borg score of 7.55 over the 24 hours before admission. Dry mouth, lack of energy, cough, sputum, difficulty sleeping, and psychological symptoms were prevalent. Pain, when reported, was of moderate intensity and contributed to distress. CONCLUSIONS/LESSONS LEARNED This study describes the patient-reported symptoms occurring during an episode of acute respiratory failure. Understanding the symptom profile of patients in this setting may allow clinicians to target symptom relief while simultaneously managing respiratory failure, enhancing care.
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Affiliation(s)
- Tracy A Smith
- UNSW Sydney, Faculty of Medicine, St Vincent's Clinical School, Sydney, Australia; Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia.
| | - Jane M Ingham
- UNSW Sydney, Faculty of Medicine, St Vincent's Clinical School, Sydney, Australia; St Vincent's Health Network, Sydney, Australia
| | - Christine R Jenkins
- Concord Hospital, Thoracic Medicine, Sydney, Australia; The George Institute, Sydney, Australia
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17
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Markussen H, Lehmann S, Nilsen RM, Natvig GK. Health-related quality of life as predictor for mortality in patients treated with long-term mechanical ventilation. BMC Pulm Med 2019; 19:13. [PMID: 30635052 PMCID: PMC6330471 DOI: 10.1186/s12890-018-0768-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background The Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV). The aim of the present study was to examine whether SRI sum scores and related subscales are associated with mortality in LTMV patients. Methods The study included 112 LTMV patients (non-invasive and invasive) from the Norwegian LTMV registry in Western Norway from 2008 with follow-up in August 2014. SRI data were obtained through a postal questionnaire, whereas mortality data were obtained from the Norwegian Cause of Death Registry. The SRI questionnaire contains 49 items and seven subscales added into a summary score (range 0–100) with higher scores indicating a better HRQoL. The association between the SRI score and mortality was estimated as hazard ratios (HRs) with 95% confidence intervals (95% CI) using Cox regression models and HRs were estimated per one unit change in the SRI score. Results Of the 112 participating patients in 2008, 52 (46%) had died by August 2014. The mortality rate was the highest in patients with chronic obstructive pulmonary disease (75%), followed by patients with neuromuscular disease (46%), obesity hypoventilation syndrome (31%) and chest wall disease (25%) (p < 0.001). Higher SRI sum scores in 2008 were associated with a lower mortality risk after adjustment for age, education, hours a day on LTMV, time since initiation of LTMV, disease category and comorbidity (HR 0.98, 95% CI: 0.96–0.99). In addition, SRI-Physical Functioning (HR 0.98, 95% CI: 0.96–0.99), SRI-Psychological Well-Being (HR 0.98, 95% CI: 0.97–0.99), and SRI-Social Functioning (HR 0.98, 95% CI: 0.97–0.99) remained significant risk factors for mortality after covariate adjustment. In the subgroup analyses of patient with neuromuscular diseases we found significant inverse associations between some of the SRI subscales and mortality. Conclusions SRI score is associated with mortality in LTMV-treated patients. We propose the use of SRI in the daily clinic with repeated measurements as part of individual follow-up. Randomized clinical trials with interventions aimed to improve HRQoL in LTMV patients should consider the SRI questionnaire as the standard HRQoL measurement. Electronic supplementary material The online version of this article (10.1186/s12890-018-0768-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi Markussen
- The Norwegian National Advisory Unit on Longterm Mechanical Ventilation, Department of Thoracic Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway. .,Department of Global Public Health and Primary Care, University in Bergen, Kalfarveien 31, 5018, Bergen, Norway.
| | - Sverre Lehmann
- The Norwegian National Advisory Unit on Longterm Mechanical Ventilation, Department of Thoracic Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Clinical Science, University in Bergen, Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Gerd K Natvig
- Department of Global Public Health and Primary Care, University in Bergen, Kalfarveien 31, 5018, Bergen, Norway
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18
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Raveling T, Bladder G, Vonk JM, Nieuwenhuis JA, Verdonk-Struik FM, Wijkstra PJ, Duiverman ML. Improvement in hypercapnia does not predict survival in COPD patients on chronic noninvasive ventilation. Int J Chron Obstruct Pulmon Dis 2018; 13:3625-3634. [PMID: 30464445 PMCID: PMC6219270 DOI: 10.2147/copd.s169951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose It has recently been shown that chronic noninvasive ventilation (NIV) improves a number of outcomes including survival, in patients with stable hypercapnic COPD. However, the mechanisms responsible for these improved outcomes are still unknown. The aim of the present study was to identify parameters associated with: 1) an improved arterial partial pressure of carbon dioxide (PaCO2) and 2) survival, in a cohort of hypercapnic COPD patients treated with chronic NIV. Patients and methods Data from 240 COPD patients treated with chronic NIV were analyzed. Predictors for the change in PaCO2 and survival were investigated using multivariate linear and Cox regression models, respectively. Results A higher level of bicarbonate before NIV initiation, the use of higher inspiratory ventilator pressures, the presence of anxiety symptoms, and NIV initiated following an exacerbation compared to NIV initiated in stable disease were associated with a larger reduction in PaCO2. A higher body mass index, a higher FEV1, a lower bicarbonate before NIV initiation, and younger age and NIV initiation in stable condition were independently associated with better survival. The change in PaCO2 was not associated with survival, neither in a subgroup of patients with a PaCO2 >7.0 kPa before the initiation of NIV. Conclusion Patients with anxiety symptoms and a high bicarbonate level at NIV initiation are potentially good responders in terms of an improvement in hypercapnia. Also, higher inspiratory ventilator pressures are associated with a larger reduction in PaCO2. However, the improvement in hypercapnia does not seem to be associated with an improved survival and emphasizes the need to look beyond PaCO2 when considering NIV initiation.
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Affiliation(s)
- Tim Raveling
- Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Gerrie Bladder
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,
| | - Judith M Vonk
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands, .,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jellie A Nieuwenhuis
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands, .,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands,
| | | | - Peter J Wijkstra
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands, .,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands,
| | - Marieke L Duiverman
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands, .,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands,
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19
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Guan L, Xu J, Wu W, Chen J, Li X, Guo B, Yang Y, Huo Y, Zhou L, Chen R. Chinese version of the severe respiratory insufficiency questionnaire for patients with COPD receiving long-term oxygen therapy. Int J Chron Obstruct Pulmon Dis 2018; 13:1537-1543. [PMID: 29785103 PMCID: PMC5955029 DOI: 10.2147/copd.s156135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with advanced-stage COPD often experience severe hypoxemia. Treatment with long-term oxygen therapy (LTOT) may relieve patients' symptoms and increase survival. As COPD is incurable, improving patients' health-related quality of life is important. The Chinese version of the Severe Respiratory Insufficiency Questionnaire (SRI) is valid for patients with hypercapnic COPD undergoing noninvasive positive airway pressure ventilation at home. However, the reliability and validity of the Chinese SRI for patients with COPD undergoing LTOT have not been investigated. Patients and methods We analyzed reliability using Cronbach's α coefficient. Construct validity was assessed with principal, exploratory, and confirmatory factor analysis. Concurrent validity was evaluated through the correlation between SRI domains and Chronic Respiratory Disease Questionnaire (CRQ) domains. Content validity was assessed by calculating the correlation between each SRI item score and the total score for the relevant domain. Results In total, 161 patients participated in this study. The Cronbach's α coefficient for all SRI domains was >0.7, except for the attendant symptoms and sleep domain. Exploratory and confirmatory factor analysis showed a good model fit for each domain, but the factors extracted from each domain were correlated. SRI and CRQ domains correlated well with respect to similar aspects of health-related quality of life, indicating good concurrent validity. Content validity was indirectly shown by a good correlation between each item score and the total score of the relevant domain. Conclusion The Chinese version of the SRI has a good reliability and validity for patients with COPD undergoing LTOT in China.
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Affiliation(s)
- Lili Guan
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiawen Xu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiliang Wu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianhua Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoying Li
- The First Affiliated Hospital, School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Bingpeng Guo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yating Huo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luqian Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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20
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Oga T, Windisch W, Handa T, Hirai T, Chin K. Health-related quality of life measurement in patients with chronic respiratory failure. Respir Investig 2018; 56:214-221. [PMID: 29773292 DOI: 10.1016/j.resinv.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/15/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
The improvement of health-related quality of life (HRQL) is an important goal in managing patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) and/or domiciliary noninvasive ventilation (NIV). Two condition-specific HRQL questionnaires have been developed to specifically assess these patients: the Maugeri Respiratory Failure Questionnaire (MRF) and the Severe Respiratory Insufficiency Questionnaire (SRI). The MRF is more advantageous in its ease of completion; conversely, the SRI measures diversified health impairments more multi-dimensionally and discriminatively with greater balance, especially in patients receiving NIV. The SRI is available in many different languages as a result of back-translation and validation processes, and is widely validated for various disorders such as chronic obstructive pulmonary disease, restrictive thoracic disorders, neuromuscular disorders, and obesity hypoventilation syndrome, among others. Dyspnea and psychological status were the main determinants for both questionnaires, while the MRF tended to place more emphasis on activity limitations than SRI. In comparison to existing generic questionnaires such as the Medical Outcomes Study 36-item short form (SF-36) and disease-specific questionnaires such as the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ), both the MRF and the SRI have been shown to be valid and reliable, and have better discriminatory, evaluative, and predictive features than other questionnaires. Thus, in assessing the HRQL of patients with CRF using LTOT and/or NIV, we might consider avoiding the use of the SF-36 or even the SGRQ or CRQ alone and consider using the CRF-specific SRI and MRF in addition to existing generic and/or disease-specific questionnaires.
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Affiliation(s)
- Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54, Kawahara, Shogoin, Sakyo-ku, Kyoto, Japan.
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany.
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54, Kawahara, Shogoin, Sakyo-ku, Kyoto, Japan.
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21
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Zhou Z, Zhou A, Zhao Y, Chen P. Evaluating the Clinical COPD Questionnaire: A systematic review. Respirology 2017; 22:251-262. [PMID: 28102972 DOI: 10.1111/resp.12970] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Abstract
The Clinical COPD Questionnaire (CCQ) is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to evaluate health status in patients with COPD. The objective of this work was to systemically assess the reliability, validity, responsiveness and minimum clinically important difference (MCID) of the CCQ. A structured search was conducted in three databases to identify articles that evaluated the psychometric properties of the CCQ in individuals with COPD. Two investigators screened the title, abstract and full text of the articles to determine study eligibility and performed the data extraction. Quality assessment of included studies was assessed by the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) checklist. Finally, 43 studies were included, over half of which had fair methodological quality. Internal consistency (reliability) of the CCQ total score ranged from 0.84 to 0.94, and test-retest reliability was 0.70-0.99. The overall CCQ had a better correlation with St George's Respiratory Questionnaire (SGRQ; from 0.71 to 0.88) and COPD Assessment Test (CAT; from 0.64 to 0.88) than modified Medical Research Council (mMRC; from 0.392 to 0.668) and forced expiratory volume in 1 s (FEV1 % predicted; from -0.31 to -0.68). Scores were different within GOLD stages, groups, composite events and co-morbidities. CCQ was sensitive to exacerbations, pulmonary rehabilitation and smoking cessation with the MCID of 0.4. The CCQ is a very useful and practical tool that can be used in clinical populations with good reliability, validity and responsiveness to interventions.
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Affiliation(s)
- Zijing Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Aiyuan Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiyang Zhao
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Chen
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
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22
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Markussen H, Lehmann S, Nilsen RM, Natvig GK. Factors associated with change in health-related quality of life among individuals treated with long-term mechanical ventilation, a 6-year follow-up study. J Adv Nurs 2017; 74:651-665. [PMID: 28983937 DOI: 10.1111/jan.13472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Abstract
AIMS To examine changes and explanatory variables for changes in health-related quality of life in patients treated with long-term mechanical ventilation over a 6-year period. BACKGROUND Long-term mechanical ventilation is a treatment for individuals with chronic hypercapnic respiratory failure, primarily caused by neuromuscular diseases, obesity hypoventilation syndrome, chronic obstructive pulmonary and restrictive thoracic diseases. Studies on long-term outcome on health-related quality of life and factors influencing it are lacking. DESIGN Prospective cohort study. METHODS Data were collected from the Norwegian Long-Term-Mechanical-Ventilation Registry and from patient-reported questionnaire in 2008 and 2014. Health-related quality of life was measured by the Severe Respiratory Insufficiency questionnaire, containing 49 items and seven subdomains. Linear mixed effects models were used to measure changes and identify factors for changes. RESULTS After 6 years, 60 patients were still participating, out of 127 at baseline. Health-related quality of life improved significantly in the total score and in four subdomains of the questionnaire. Satisfaction with training in long-term mechanical ventilation was an explanatory variable for improved 'psychological well-being' and follow-up for improvement of 'anxiety'. Side effects of the treatment like facial soreness were associated with the total score. High age and high forced vital capacity were related to lower 'physical function' and improved 'social functioning', respectively. CONCLUSION Long-term mechanical ventilation over 6 years improved health-related quality of life in most patients. Patient training, follow-up and reduction of side effects, largely delivered by trained nurses, contribute to achieve the main goal of the treatment-improved health-related quality of life.
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Affiliation(s)
- Heidi Markussen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sverre Lehmann
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Roy M Nilsen
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Gerd K Natvig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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23
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Chen R, Guan L, Wu W, Yang Z, Li X, Luo Q, Liang Z, Wang F, Guo B, Huo Y, Yang Y, Zhou L. The Chinese version of the Severe Respiratory Insufficiency questionnaire for patients with chronic hypercapnic chronic obstructive pulmonary disease receiving non-invasive positive pressure ventilation. BMJ Open 2017; 7:e017712. [PMID: 28851800 PMCID: PMC5724189 DOI: 10.1136/bmjopen-2017-017712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The Severe Respiratory Insufficiency (SRI) questionnaire is the best assessment tool for health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) receiving non-invasive positive pressure ventilation (NIPPV). This study aimed to translate the SRI Questionnaire into Chinese and to validate it. DESIGN Prospective validation study. SETTING AND PARTICIPANTS A total of 149 participants with chronic hypercapnic COPD receiving NIPPV completed the study. METHODS The SRI questionnaire was translated into Chinese using translation and back-translation. Reliability was gauged using Cronbach's α coefficient. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess construct validity. Content validity was confirmed by evaluating the relationship between the score of each item and the total score of the relevant subscale. RESULTS Cronbach's α coefficients for each subscale and summary scale were above 0.7. Using EFA, one factor was extracted from the anxiety and summary scales and two factors were extracted from the remaining six subscales. Based on the EFA results, subsequent CFA revealed a good model fit for each subscale, but the extracted factors of each subscale were correlated. Content validity was confirmed by the good relationship between the score of each item and the total score of the relevant subscale. CONCLUSION The Chinese version of the SRI questionnaire is valid and reliable for patients with chronic hypercapnic COPD receiving NIPPV in China. TRIAL REGISTRATION NUMBER NCT02499718.
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Affiliation(s)
- Rongchang Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lili Guan
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiliang Wu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaoying Li
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qun Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bingpeng Guo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yating Huo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luqian Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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24
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Lecheler L, Richter M, Franzen DP, Rampini SK, Cheetham M, Jenewein J, Battegay E, Nowak A. The frequent and underrecognised co-occurrence of acute exacerbated COPD and depression warrants screening: a systematic review. Eur Respir Rev 2017; 26:26/144/170026. [PMID: 28615309 DOI: 10.1183/16000617.0026-2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/26/2017] [Indexed: 11/05/2022] Open
Abstract
Patients with acute exacerbated chronic obstructive pulmonary disease (AECOPD) and concurrent depression suffer significant psychological stress and decreased quality of life. The aim of this study was to collate data, guidelines and recommendations from publications on the screening and management of depressive mood disorders in patients hospitalised with AECOPD.We systematically searched four databases for publications reporting screening or management of depression in patients hospitalised for AECOPD. The identification of articles was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.Out of 1494 original articles screened, 35 met all inclusion criteria. These report a prevalence of depression in AECOPD ranging between 9.5% and 85.6%. Some studies report high postadmission mortality rates for depressive AECOPD patients, and higher readmission rates in depressive versus nondepressive AECOPD patients. Importantly, none of the 35 publications included suggestions on the screening and management of depression in AECOPD.Depression and AECOPD frequently co-occur, and this worsens outcomes. Yet we did not find recommendations on management, and few interventional studies. Patients hospitalised with AECOPD should be systematically screened for depression and treatment recommendations should be developed for these patients. Randomised studies on how to screen and treat depression in hospitalised AECOPD are necessary.
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Affiliation(s)
- Leopold Lecheler
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Daniel P Franzen
- Dept of Respiratory Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvana K Rampini
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marcus Cheetham
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Josef Jenewein
- Dept of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Albina Nowak
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
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25
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Comparison of Different Disease-Specific Health-Related Quality of Life Measurements in Patients with Long-Term Noninvasive Ventilation. Can Respir J 2017; 2017:8295079. [PMID: 28588383 PMCID: PMC5447275 DOI: 10.1155/2017/8295079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/24/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Two disease-specific questionnaires have been developed to assess health-related quality of life (HRQL) in patients with chronic respiratory failure: the Severe Respiratory Insufficiency (SRI) Questionnaire and the Maugeri Respiratory Failure (MRF) Questionnaire. We aimed to compare the characteristics of the SRI, MRF-26, and St. George's Respiratory Questionnaire (SGRQ) for use in patients with home noninvasive ventilation (NIV). METHODS Fifty-six outpatients receiving long-term NIV were recruited and underwent assessments of pulmonary function, arterial blood gas, HRQL, dyspnea, and psychological status. RESULTS Correlations of the SRI and MRF-26 with the SGRQ were modest. While pulmonary function was weakly related to only some domains of the SRI and MRF-26, the modified Medical Research Council (mMRC) dyspnea scale and Hospital Anxiety and Depression Scale (HADS) were significantly related to all domains of the SRI and MRF-26. Multiple regression analyses showed that HADS depression and mMRC accounted for 34% and 27% of the variance in the SRI, 24% and 37% in the MRF-26, and 17% and 46% in the SGRQ, respectively. CONCLUSIONS The SRI and MRF-26 were reliable questionnaires for patients receiving long-term NIV. Dyspnea and psychological status were their main common determinants. The SRI covers more psychological health impairments than the MRF. This trial is registered with ClinicalTrials.gov Identifier: NCT00905476.
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26
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Schwarz SB, Magnet FS, Windisch W. Why High-Intensity NPPV is Favourable to Low-Intensity NPPV: Clinical and Physiological Reasons. COPD 2017; 14:389-395. [DOI: 10.1080/15412555.2017.1318843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S. B. Schwarz
- Faculty of Health/School of Medicine, Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Germany
| | - F. S. Magnet
- Faculty of Health/School of Medicine, Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Germany
| | - W. Windisch
- Faculty of Health/School of Medicine, Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Germany
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27
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Validation of the Japanese Severe Respiratory Insufficiency Questionnaire in hypercapnic patients with noninvasive ventilation. Respir Investig 2017; 55:166-172. [PMID: 28274533 DOI: 10.1016/j.resinv.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/15/2016] [Accepted: 12/08/2016] [Indexed: 11/22/2022]
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28
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Ribeiro C, Ferreira D, Conde S, Oliveira P, Windisch W. Validation of the Portuguese Severe Respiratory Insufficiency Questionnaire for home mechanically ventilated patients. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:139-145. [PMID: 28238622 DOI: 10.1016/j.rppnen.2017.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 12/30/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022] Open
Abstract
The aim of this study was to develop and validate the professional translation and cultural adaptation of the Portuguese Severe Respiratory Insufficiency (SRI) Questionnaire. The sample was composed of 93 patients (50 male patients, 53.8%) with a mean age of 66.3 years. The most frequent diagnostic groups were chronic obstructive pulmonary disease, obesity hypoventilation syndrome and restrictive chest wall disorders. The patients were asked to fill in both the SRI and SF-36 questionnaires. Factor analysis of the SRI questionnaire was performed leading to an explained variance of 73%, and resulted in 13 components. When analyzing the reliability, we obtained values for Cronbach's alpha above 0.70 for most subscales with the reliability of the summary scale being even higher (0.84). This professional translation and cultural adaptation of the Portuguese SRI Questionnaire has good psychometric properties which are similar, not only to the original, but also to other translations. These characteristics make this questionnaire applicable to the Portuguese population receiving home mechanical ventilation for severe respiratory insufficiency.
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Affiliation(s)
- C Ribeiro
- Pneumology Department - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
| | - D Ferreira
- Pneumology Department - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - S Conde
- Pneumology Department - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - P Oliveira
- ISPUP-EPIUnit, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
| | - W Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
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29
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Dretzke J, Blissett D, Dave C, Mukherjee R, Price M, Bayliss S, Wu X, Jordan R, Jowett S, Turner AM, Moore D. The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-246. [PMID: 26470875 DOI: 10.3310/hta19810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the U.K., domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation. DATA SOURCES Bibliographic databases, conference proceedings and ongoing trial registries up to September 2014. METHODS Standard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately. RESULTS Thirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective. LIMITATIONS Evidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data. CONCLUSIONS The cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings. FUTURE WORK RECOMMENDATIONS The results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003286. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Janine Dretzke
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Deirdre Blissett
- Health Economics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Chirag Dave
- Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Rahul Mukherjee
- Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Malcolm Price
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Sue Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Xiaoying Wu
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Jordan
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham, UK.,Queen Elizabeth Hospital Research Laboratories, University of Birmingham, Birmingham, UK
| | - David Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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Oga T, Taniguchi H, Kita H, Tsuboi T, Tomii K, Ando M, Kojima E, Tomioka H, Taguchi Y, Kaji Y, Maekura R, Hiraga T, Sakai N, Kimura T, Mishima M, Chin K. Analysis of the relationship between health status and mortality in hypercapnic patients with noninvasive ventilation. CLINICAL RESPIRATORY JOURNAL 2015; 11:772-780. [PMID: 26605994 DOI: 10.1111/crj.12415] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 09/13/2015] [Accepted: 11/13/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Toru Oga
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy; Tosei General Hospital; Aichi Japan
| | - Hideo Kita
- Department of Respiratory Medicine; Takatsuki Red Cross Hospital; Osaka Japan
| | - Tomomasa Tsuboi
- Department of Respiratory Medicine; National Hospital Organization Minami-Kyoto Hospital; Kyoto Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine; Kobe City Medical Center General Hospital; Hyogo Japan
| | - Morihide Ando
- Department of Pulmonary Medicine; Ogaki Municipal Hospital; Gifu Japan
| | - Eiji Kojima
- Department of Respiratory Medicine; Komaki City Hospital; Aichi Japan
| | - Hiromi Tomioka
- Department of Respiratory Medicine; Kobe City Medical Center West Hospital; Hyogo Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine; Tenri Hospital; Nara Japan
| | - Yusuke Kaji
- Department of Respiratory Medicine; Tenri Hospital; Nara Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine; National Hospital Organization Toneyama Hospital; Osaka Japan
| | - Toru Hiraga
- Department of Respiratory Medicine; National Hospital Organization Toneyama Hospital; Osaka Japan
| | - Naoki Sakai
- Department of Respiratory Medicine; Otsu Red Cross Hospital; Shiga Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy; Tosei General Hospital; Aichi Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
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Windisch W, Storre JH, Köhnlein T. Nocturnal non-invasive positive pressure ventilation for COPD. Expert Rev Respir Med 2015; 9:295-308. [DOI: 10.1586/17476348.2015.1035260] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Struik FM, Sprooten RTM, Kerstjens HAM, Bladder G, Zijnen M, Asin J, Cobben NAM, Vonk JM, Wijkstra PJ. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study. Thorax 2014; 69:826-34. [PMID: 24781217 DOI: 10.1136/thoraxjnl-2014-205126] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The effectiveness of non-invasive positive pressure ventilation (NIV) in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure (ARF) remains unclear. We investigated if nocturnal NIV in these patients prolongs the time to readmission for respiratory causes or death (primary endpoint) in the following 12 months. METHODS 201 COPD patients admitted to hospital with ARF and prolonged hypercapnia >48 h after termination of ventilatory support were randomised to NIV or standard treatment. Secondary outcomes were daytime arterial blood gasses, transcutaneous PCO2 during the night, lung function, health-related quality-of-life (HRQL), mood state, daily activities and dyspnoea. RESULTS 1 year after discharge, 65% versus 64% of patients (NIV vs standard treatment) were readmitted to hospital for respiratory causes or had died; time to event was not different (p=0.85). Daytime PaCO2 was significantly improved in NIV versus standard treatment (PaCO2 0.5 kPa (95% CI 0.04 to 0.90, p=0.03)) as was transcutaneous PCO2 during the night. HRQL showed a trend (p=0.054, Severe Respiratory Insufficiency questionnaire) in favour of NIV. Number of exacerbations, lung function, mood state, daily activity levels or dyspnoea was not significantly different. DISCUSSIONS We could not demonstrate an improvement in time to readmission or death by adding NIV for 1 year in patients with prolonged hypercapnia after an episode of NIV for ARF. There is no reason to believe the NIV was not effective since daytime PaCO2 and night-time PCO2 improved. The trend for improvement in HRQL favouring NIV we believe nevertheless should be explored further. TRIAL REGISTRATION NUMBER NTR1100.
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Affiliation(s)
- F M Struik
- Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - R T M Sprooten
- Department of Respiratory Medicine/Center of Home Mechanical Ventilation Maastricht, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - H A M Kerstjens
- Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - G Bladder
- Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - M Zijnen
- Department of Intensive Care/Center for Home Mechanical Ventilation, University Medical Centre, Erasmus MC, Rotterdam, The Netherlands
| | - J Asin
- Department of Pulmonology, Amphia Hospital, Breda, The Netherlands
| | - N A M Cobben
- Department of Respiratory Medicine/Center of Home Mechanical Ventilation Maastricht, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - J M Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Department of Epidemiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - P J Wijkstra
- Department of Pulmonology/Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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Struik FM, Lacasse Y, Goldstein RS, Kerstjens HAM, Wijkstra PJ. Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis. Respir Med 2013; 108:329-37. [PMID: 24157199 DOI: 10.1016/j.rmed.2013.10.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/04/2013] [Accepted: 10/06/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The effects of nocturnal noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) remain controversial. METHODS The Cochrane Airways group Register of Trials, MEDLINE, EMBASE and CINAHL were searched up to August 2012. Individual patient data from randomised controlled trials on NIPPV outcomes were selected for two separate meta-analyses: the first with follow-up of 3 months and the second with 12 months of follow-up. Additionally, subgroup analyses within the NIPPV group comparing IPAP levels, compliance and levels of hypercapnia on change in PaCO2 after 3 months were performed. RESULTS Seven trials (245 patients) were included. All studies were considered of moderate to high quality. No significant difference was found between NIPPV and control groups after 3 or 12 months of follow-up when looking at PaCO2 and PaO2, 6-minute walking distance, health-related quality-of-life, forced expiratory volume in 1 s, forced vital capacity, maximal inspiratory pressure and sleep efficiency. Significant differences in change in PaCO2 after 3 months were found for patients ventilated with IPAP levels of at least 18 cm H2O, for patients who used NIPPV for at least 5 h per night as well as for patients with baseline PaCO2 of at least 55 mm Hg when compared to patients with lower IPAP levels, poorer compliance or lower levels of hypercapnia. DISCUSSION At present, there is insufficient evidence to support the application of routine NIPPV in patients with stable COPD. However, higher IPAP levels, better compliance and higher baseline PaCO2 seem to improve PaCO2.
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Affiliation(s)
- F M Struik
- Department of Pulmonology, Center for Home Mechanical Ventilation, University of Groningen, Groningen University Medical Center Groningen (UMCG), Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen University Medical Center Groningen (UMCG), Groningen, The Netherlands.
| | - Y Lacasse
- Centre de Pneumologie, Institute Universitaire de Cardiologie et de Pneumologie de Québec, Hôpital Laval, Québec, Canada
| | - R S Goldstein
- Division of Respiratory Medicine, West Park Healthcare Centre, University of Toronto, Toronto, Canada
| | - H A M Kerstjens
- Department of Pulmonology, Center for Home Mechanical Ventilation, University of Groningen, Groningen University Medical Center Groningen (UMCG), Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - P J Wijkstra
- Department of Pulmonology, Center for Home Mechanical Ventilation, University of Groningen, Groningen University Medical Center Groningen (UMCG), Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen University Medical Center Groningen (UMCG), Groningen, The Netherlands
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