Long-term outcomes after acute hypercapnic COPD exacerbation : First-ever episode of non-invasive ventilation

Wien Klin Wochenschr. 2018 Oct;130(19-20):561-568. doi: 10.1007/s00508-018-1364-6. Epub 2018 Jul 31.


Background: Non-invasive ventilation (NIV) is used to treat acute hypercapnic respiratory failure (AHRF) in patients with chronic obstructive pulmonary disease (COPD); however, long-term outcomes following discharge are largely unknown. This study aimed to characterize long-term outcomes and identify associated markers in patients with COPD after surviving the first episode of HRF requiring NIV.

Methods: This study retrospectively analyzed 122 patients, mean age 62 ± 8 years, 52% female and forced expiratory volume in 1 s (FEV1) predicted 30 ± 13%, admitted with an acute hypercapnic exacerbation of COPD and receiving a first-ever NIV treatment between 2000 and 2012.

Results: A total of 40% of the patients required hospital readmission due to respiratory reasons within 1 year. Persistent hypercapnia leading to the prescription of domiciliary NIV, older age and lower body mass index (BMI) were risk factors for readmission due to respiratory reasons. Survival rates were 79% and 63% at 1 and 2 years after discharge, respectively. A shorter time to readmission and recurrent hypercapnic failure, lower BMI and acidemia on the first admission, as well as hypercapnia at hospital discharge were correlated with a decreased long-term survival.

Conclusion: Patients with COPD surviving their first episode of AHRF requiring NIV are at high risk for readmission and death. Severe respiratory acidosis, chronic respiratory failure and a lower BMI imply shorter long-term survival.

Keywords: COPD; COPD exacerbation; Long-term outcome; Non-invasive ventilation.

MeSH terms

  • Aged
  • Female
  • Humans
  • Hypercapnia
  • Male
  • Middle Aged
  • Noninvasive Ventilation*
  • Pulmonary Disease, Chronic Obstructive*
  • Respiratory Insufficiency* / therapy
  • Retrospective Studies