Pathophysiological mechanism of long-term noninvasive ventilation in stable hypercapnic patients with COPD using functional respiratory imaging
Authors Hajian B, De Backer J, Sneyers C, Ferreira F, Barboza KC, Leemans G, Vos W, De Backer W
Received 7 March 2017
Accepted for publication 5 June 2017
Published 28 July 2017 Volume 2017:12 Pages 2197—2205
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Bita Hajian,1 Jan De Backer,2 Claire Sneyers,3 Francisca Ferreira,2 Katherine C Barboza,2 Glenn Leemans,1 Wim Vos,2 Wilfried De Backer1
1Department of Respiratory Medicine, University Hospital Antwerp, 2FLUIDDA nv, 3Department of Physical Medicine, Monica Hospital, Antwerp, Belgium
Introduction: Patients with severe COPD often develop chronic hypercapnic respiratory failure. Their prognosis worsens and they are more likely to develop exacerbations. This has major influence on the health-related quality of life. Currently, there is no information about the success of long-term noninvasive ventilation (NIV) among patients who receive NIV in acute settings. Also, little is known about the pathophysiological mechanism of NIV.
Methods: Ten Global Initiative for Obstructive Lung Disease stage III and IV COPD patients with respiratory failure who were hospitalized following acute exacerbation were treated with NIV using a Synchrony BiPAP device for 6 months. Arterial blood gases and lung function parameters were measured. Low-dose computed tomography of the thorax was performed and used for segmentation. Further analyses provided lobe volume, airway volume, and airway resistance, giving an overall functional description of the separate airways and lobes. Ventilation perfusion (VQ) was calculated. Patient-reported outcomes were evaluated.
Results: PaCO2 significantly improved from 50.03 mmHg at baseline to 44.75 mmHg after 1 month and 43.37 mmHg after 6 months (P=0.006). Subjects showed improvement in the 6-minute walk tests (6MWTs) by an average of 51 m (from 332 m at baseline to 359 m at 1 month and 383 m at 6 months). Patients demonstrated improvement in self-reported anxiety (P=0.018). The improvement in image-based VQ was positively associated with the 6MWT and the anxiety domain of the Severe Respiratory Insufficiency Questionnaire.
Conclusion: Though previous studies of long-term NIV have shown conflicting results, this study demonstrates that patients can benefit from long-term NIV treatment, resulting in improved VQ, gas exchange, and exercise tolerance.
Keywords: noninvasive ventilation, COPD, functional respiratory imaging, ventilation perfusion, BiPAP, hypercapnia, exacerbations
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