Long-term non-invasive ventilation in COPD after acute-on-chronic respiratory failure

Respir Med. 2011 Mar;105(3):427-34. doi: 10.1016/j.rmed.2010.09.005. Epub 2010 Nov 26.


Background: COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation have a poor prognosis. Long-term nocturnal non-invasive ventilation (NIV) may be beneficial for these patients. We hypothesized that stable patients on long-term NIV would experience clinical worsening after withdrawal of NIV.

Methods: We included 26 consecutive COPD patients (63 ± 6 years, 58% male, FEV(1) 31 ± 14% predicted) who remained hypercapnic after acute respiratory failure requiring mechanical ventilation. After a six month run-in period, during which all patients received NIV, they were randomised to either continue (ventilation group, n = 13) or to stop NIV (withdrawal group, n = 13). The primary endpoint was time to clinical worsening defined as an escalation of mechanical ventilation.

Results: All patients remained stable during the run-in period. After randomisation the withdrawal group had a higher probability of clinical worsening compared to the ventilation group (p = 0.0018). After 12 months, ten patients (77%) in the withdrawal group, but only two patients (15%) in the ventilation group, experienced clinical worsening (p = 0.0048). Six-minute walking distance increased in the ventilation group.

Conclusion: COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation may benefit from long-term NIV.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chronic Disease
  • Critical Care
  • Disease Progression
  • Female
  • Humans
  • Hypercapnia / physiopathology
  • Hypercapnia / rehabilitation
  • Hypercapnia / therapy*
  • Long-Term Care
  • Male
  • Middle Aged
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Respiration, Artificial / methods*
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / rehabilitation
  • Respiratory Insufficiency / therapy*
  • Spirometry
  • Treatment Outcome