Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure

Ingrid L Titlestad,¹ Annmarie T Lassen,² Jørgen Vestbo<sup>1,3

1</sup>Department of Respiratory Medicine, ²Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark; ³Respiratory Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK

Abstract: Implementation of noninvasive ventilation (NIV) as an add-on treatment has been routinely used in a non-intensive care setting since 2004 for patients with chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure at a university hospital in Denmark. Although randomized controlled trials show lowered mortality rates in highly selected patients with acute exacerbation and respiratory failure, there are only few reports on long-term survival after receiving NIV. We present long-term all-cause mortality data from patients receiving NIV for the first time.
Method: Data from medical records were retrospectively retrieved from all patients receiving NIV for the first time after being admitted acutely to an acute medical ward and further transfer to a respiratory ward with respiratory failure and a diagnosis of COPD in the period January 1, 2005 to December 31, 2007; patients were followed until January 2012. Demographic data collected included age, sex, diagnoses at discharge, and, when present, FEV₁; a “not-to-intubate” order was also registered when listed.
Results: In total, 253 patients (143 female, 110 male) received NIV for the first time. The median age was 72 years (range 46–91 years). The 30-day mortality rate was 29.3%. The 5-year survival rate was 23.7%. Women showed a trend towards better survival than men (25.7% vs 19.2%, P = 0.25), and the trend was even more pronounced for patients with COPD.
Conclusion: The mortality rate of patients receiving NIV is high, as expected in a real-life setting, but with a 5-year survival rate of 23.7% with a trend towards more female than male long-term survivors.

Keywords: COPD, acute respiratory failure, NIV, long-term survival

A Letter to the Editor has been received and published for this article.