Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV.

Trethewey, Samuel P, Edgar, Ross G, Morlet, Julien, Mukherjee, Rahul and Turner, Alice M (2019) Late presentation of acute hypercapnic respiratory failure carries a high mortality risk in COPD patients treated with ward-based NIV. Respiratory medicine, 151. pp. 128-132. ISSN 1532-3064. This article is available to all UHB staff and students via ASK Discovery tool by using their UHB Open Athens login

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Official URL: https://www.resmedjournal.com/article/S0954-6111(1...

Abstract

INTRODUCTION

Non-invasive ventilation (NIV) is recommended for treatment of acute hypercapnic respiratory failure (AHRF) refractory to medical management in patients with COPD. This study investigated the relationship between time from hospital presentation to diagnosis of AHRF and in-hospital mortality.

METHODS

Retrospective analysis of hospitalised COPD patients treated with a first episode of ward-based NIV for AHRF at a large UK teaching hospital between 2004 and 2017. Data collected prospectively as part of NIV service evaluation. Multivariable logistic regression performed to identify predictors of in-hospital mortality.

RESULTS

In total, 547 unique patients were studied comprising 245 males (44.8%), median age 70.6 years, median FEV1% predicted 34%. Overall in-hospital mortality was 19% (n = 104); median survival was 1.7 years. In univariate analysis, a longer time between hospital presentation to diagnosis of AHRF was associated with in-hospital mortality (median [IQR]: 8.7 [0.7-75.8] hours vs. 1.9 [0.3-13.6] hours, p < 0.0001). In multivariable logistic regression, significant predictors of in-hospital mortality were AHRF >24 h after hospital presentation (odds ratio [95% CI]: 2.29 [1.33-3.95], p = 0.003), pneumonia on admission (1.81 [1.07-3.08], p = 0.027), increased age (1.10 [1.07-1.14], p < 0.001) and NIV as ceiling of treatment (5.86 [2.87-11.94], p < 0.001).

CONCLUSIONS

Hospitalised COPD patients with late presentation of AHRF, requiring acute ward-based NIV, may have increased in-hospital mortality. These patients may benefit from closer monitoring and earlier specialist respiratory review.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool by using their UHB Open Athens login
Subjects: WF Respiratory system. Respiratory medicine
Divisions: Emergency Services > Therapies
Planned IP Care > Respiratory Medicine
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Depositing User: Beth Connors
Date Deposited: 11 May 2020 13:03
Last Modified: 11 May 2020 13:03
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3057

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