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Struik FM, Wijkstra PJ. Response to: Domiciliary long term non-invasive ventilation in COPD: should we select subgroups with a better likelihood to respond to NIV in subsequent randomised controlled trials? Thorax 2014; 69:1143-4. [PMID: 25122088 DOI: 10.1136/thoraxjnl-2014-206066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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
| | - 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, 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: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Duiverman ML, Struik FM, Wijkstra PJ. Noninvasive ventilation in severe stable COPD: is it effective, and if so, in what way? Eur Respir J 2008; 31:1136-7; author reply 1137. [PMID: 18448509 DOI: 10.1183/09031936.00168207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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