Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation?
Background and objective: Non-invasive ventilation (NIV) improves survival of patients with chronic respiratory failure (CRF). Most often, pressure settings are made to normalize arterial blood gases. However, this objective is not always achieved due to intolerance to increased pressure or poor com...
| Príomhchruthaitheoirí: | , , , , , , , , , |
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| Formáid: | Alt |
| Teanga: | English |
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Elsevier
2024-02-01
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| Sraith: | Heliyon |
| Ábhair: | |
| Rochtain ar líne: | http://www.sciencedirect.com/science/article/pii/S240584402402468X |
| _version_ | 1827322176779321344 |
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| author | Audrey Thomas Sandrine Jaffré Vianney Guardiolle Tanguy Perennec Frédéric Gagnadoux François Goupil Cédric Bretonnière Vivien Danielo Jean Morin François-Xavier Blanc |
| author_facet | Audrey Thomas Sandrine Jaffré Vianney Guardiolle Tanguy Perennec Frédéric Gagnadoux François Goupil Cédric Bretonnière Vivien Danielo Jean Morin François-Xavier Blanc |
| author_sort | Audrey Thomas |
| collection | DOAJ |
| description | Background and objective: Non-invasive ventilation (NIV) improves survival of patients with chronic respiratory failure (CRF). Most often, pressure settings are made to normalize arterial blood gases. However, this objective is not always achieved due to intolerance to increased pressure or poor compliance. Few studies have assessed the effect of persistent hypercapnia on ventilated patients’ survival. Data from the Pays de la Loire Respiratory Health Research Institute cohort were analyzed to answer this question. Study design and methods: NIV-treated adults enrolled between 2009 and 2019 were divided into 5 subgroups: obesity-hypoventilation syndrome (OHS), COPD, obese COPD, neuromuscular disease (NMD) and chest wall disease (CWD). PaCO2 correction was defined as the achievement of a PaCO2 < 6 kPa or a 20% decrease in baseline PaCO₂ in COPD patients. The endpoint was all-cause mortality. Follow-up was censored in case of NIV discontinuation. Results: Data from 431 patients were analyzed. Median survival was 103 months and 148 patients died. Overall, PaCO2 correction was achieved in 74% of patients. Bivariate analysis did not show any survival difference between patients who achievedPaCO₂ correction and those who remained hypercapnic: overall population: p = 0.74; COPD: p = 0.97; obese COPD: p = 0.28; OHS: p = 0.93; NMD: p = 0.84; CWD: p = 0.28. Conclusion: Moderate residual hypercapnia under NIV does not negatively impact survival in CRF patients. In individuals with poor tolerance of pressure increases, residual hypercapnia can therefore be tolerated under long-term NIV. Larger studies, especially with a higher number of patients with residual PaCO2 > 7 kPa, are needed to confirm these results. |
| first_indexed | 2024-03-07T22:54:28Z |
| format | Article |
| id | doaj.art-95e194292f964f5dad7cee450e40cc0a |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-25T01:20:31Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-95e194292f964f5dad7cee450e40cc0a2024-03-09T09:28:17ZengElsevierHeliyon2405-84402024-02-01104e26437Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation?Audrey Thomas0Sandrine Jaffré1Vianney Guardiolle2Tanguy Perennec3Frédéric Gagnadoux4François Goupil5Cédric Bretonnière6Vivien Danielo7Jean Morin8François-Xavier Blanc9Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France; Corresponding author. CHU Nantes, Service de Pneumologie, Hôpital G. et R Laënnec, Bd J. Monod, 44093 Nantes cedex 1, France.Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, FranceNantes Université, CHU Nantes, Data Clinic, INSERM CIC 1413, Nantes, FranceRadiotherapy Department, West Cancer Institute, Saint Herblain, FranceDepartment of Respiratory and Sleep Medicine, Angers University Hospital, Angers, FranceDepartment of Respiratory Diseases, Le Mans General Hospital, Le Mans, FranceNantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, FranceNantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, FranceNantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, FranceNantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, FranceBackground and objective: Non-invasive ventilation (NIV) improves survival of patients with chronic respiratory failure (CRF). Most often, pressure settings are made to normalize arterial blood gases. However, this objective is not always achieved due to intolerance to increased pressure or poor compliance. Few studies have assessed the effect of persistent hypercapnia on ventilated patients’ survival. Data from the Pays de la Loire Respiratory Health Research Institute cohort were analyzed to answer this question. Study design and methods: NIV-treated adults enrolled between 2009 and 2019 were divided into 5 subgroups: obesity-hypoventilation syndrome (OHS), COPD, obese COPD, neuromuscular disease (NMD) and chest wall disease (CWD). PaCO2 correction was defined as the achievement of a PaCO2 < 6 kPa or a 20% decrease in baseline PaCO₂ in COPD patients. The endpoint was all-cause mortality. Follow-up was censored in case of NIV discontinuation. Results: Data from 431 patients were analyzed. Median survival was 103 months and 148 patients died. Overall, PaCO2 correction was achieved in 74% of patients. Bivariate analysis did not show any survival difference between patients who achievedPaCO₂ correction and those who remained hypercapnic: overall population: p = 0.74; COPD: p = 0.97; obese COPD: p = 0.28; OHS: p = 0.93; NMD: p = 0.84; CWD: p = 0.28. Conclusion: Moderate residual hypercapnia under NIV does not negatively impact survival in CRF patients. In individuals with poor tolerance of pressure increases, residual hypercapnia can therefore be tolerated under long-term NIV. Larger studies, especially with a higher number of patients with residual PaCO2 > 7 kPa, are needed to confirm these results.http://www.sciencedirect.com/science/article/pii/S240584402402468XChronic obstructive pulmonary diseaseChronic respiratory failureNon-invasive ventilationObesity-hypoventilation syndromeHypercapniaSurvival |
| spellingShingle | Audrey Thomas Sandrine Jaffré Vianney Guardiolle Tanguy Perennec Frédéric Gagnadoux François Goupil Cédric Bretonnière Vivien Danielo Jean Morin François-Xavier Blanc Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation? Heliyon Chronic obstructive pulmonary disease Chronic respiratory failure Non-invasive ventilation Obesity-hypoventilation syndrome Hypercapnia Survival |
| title | Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation? |
| title_full | Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation? |
| title_fullStr | Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation? |
| title_full_unstemmed | Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation? |
| title_short | Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation? |
| title_sort | does paco2 correction have an impact on survival of patients with chronic respiratory failure and long term non invasive ventilation |
| topic | Chronic obstructive pulmonary disease Chronic respiratory failure Non-invasive ventilation Obesity-hypoventilation syndrome Hypercapnia Survival |
| url | http://www.sciencedirect.com/science/article/pii/S240584402402468X |
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