Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 6

The effects of long-term noninvasive ventilation in hypercapnic COPD patients: a randomized controlled pilot study

Authors De Backer L, Vos W, Dieriks B, Daems D, Verhulst S, Vinchurkar S, Ides K, De Backer J, Germonpre P, De Backer W

Published 18 November 2011 Volume 2011:6 Pages 615—624

DOI https://doi.org/10.2147/COPD.S22823

Review by Single-blind

Peer reviewer comments 2

L De Backer¹, W Vos², B Dieriks¹, D Daems¹, S Verhulst¹, S Vinchurkar², K Ides¹, J De Backer², P Germonpre¹, W De Backer¹
1Antwerp University Hospital, Department of Respiratory Medicine, 2FluidDa, Antwerp, Belgium

Introduction: Noninvasive ventilation (NIV) is a well-established treatment for acute-on-chronic respiratory failure in hypercapnic COPD patients. Less is known about the effects of a long-term treatment with NIV in hypercapnic COPD patients and about the factors that may predict response in terms of improved oxygenation and lowered CO2 retention.
Methods: In this study, we randomized 15 patients to a routine pharmacological treatment (n = 5, age 66 [standard deviation ± 6] years, FEV1 30.5 [±5.1] %pred, PaO2 65 [±6] mmHg, PaCO2 52.4 [±6.0] mmHg) or to a routine treatment and NIV (using the Synchrony BiPAP device [Respironics, Inc, Murrsville, PA]) (n = 10, age 65 [±7] years, FEV1 29.5 [±9.0] %pred, PaO2 59 [±13] mmHg, PaCO2 55.4 [±7.7] mmHg) for 6 months. We looked at arterial blood gasses, lung function parameters and performed a low-dose computed tomography of the thorax, which was later used for segmentation (providing lobe and airway volumes, iVlobe and iVaw) and post-processing with computer methods (providing airway resistance, iRaw) giving overall a functional image of the separate airways and lobes.
Results: In both groups there was a nonsignificant change in FEV1 (NIV group 29.5 [9.0] to 38.5 [14.6] %pred, control group 30.5 [5.1] to 36.8 [8.7] mmHg). PaCO2 dropped significantly only in the NIV group (NIV: 55.4 [7.7] → 44.5 [4.70], P = 0.0076; control: 52.4 [6.0] → 47.6 [8.2], NS). Patients actively treated with NIV developed a more inhomogeneous redistribution of mass flow than control patients. Subsequent analysis indicated that in NIV-treated patients that improve their blood gases, mass flow was also redistributed towards areas with higher vessel density and less emphysema, indicating that flow was redistributed towards areas with better perfusion. There was a highly significant correlation between the % increase in mass flow towards lobes with a blood vessel density of >9% and the increase in PaO2. Improved ventilation–perfusion match and recruitment of previously occluded small airways can explain the improvement in blood gases.
Conclusion: We can conclude that in hypercapnic COPD patients treated with long-term NIV over 6 months, a mass flow redistribution occurs, providing a better ventilation–perfusion match and hence better blood gases and lung function. Control patients improve homogeneously in iVaw and iRaw, without improvement in gas exchange since there is no improved ventilation/perfusion ratio or increased alveolar ventilation. These differences in response can be detected through functional imaging, which gives a more detailed report on regional lung volumes and resistances than classical lung function tests do. Possibly only patients with localized small airway disease are good candidates for long-term NIV treatment. To confirm this and to see if better arterial blood gases also lead to better health related quality of life and longer survival, we have to study a larger population.

Keywords: noninvasive ventilation, COPD, imaging

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Other article by this author:

Functional imaging using computer methods to compare the effect of salbutamol and ipratropium bromide in patient-specific airway models of COPD

De Backer LA, Vos WG, Salgado R, De Backer JW, Devolder A, Verhulst SL, Claes R, Germonpré PR, De Backer WA

International Journal of Chronic Obstructive Pulmonary Disease 2011, 6:637-646

Published Date: 28 November 2011

Readers of this article also read:

Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

Salturk C, Karakurt Z, Takir HB, Balci M, Kargin F, Mocin OY, Gungor G, Ozmen I, Oztas S, Yalcinsoy M, Evin R, Ozturk M, Adiguzel N

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2559-2569

Published Date: 26 November 2015

Value of systematic intervention for chronic obstructive pulmonary disease in a regional Japanese city based on case detection rate and medical cost

Tawara Y, Senjyu H, Tanaka K, Tanaka T, Asai M, Kozu R, Tabusadani M, Honda S, Sawai T

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1531-1542

Published Date: 3 August 2015

Variants in multiple genes polymorphism association analysis of COPD in the Chinese Li population

Ding Y, Yang D, Zhou L, Xu J, Chen Y, He P, Yao J, Chen J, Niu H, Sun P, Jin T

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1455-1463

Published Date: 27 July 2015

Effects of indacaterol versus tiotropium on respiratory mechanics assessed by the forced oscillation technique in patients with chronic obstructive pulmonary disease

Inui N, Matsushima S, Kato S, Yasui H, Kono M, Fujisawa T, Enomoto N, Nakamura Y, Toyoshima M, Suda T

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1139-1146

Published Date: 17 June 2015

Toxicity of pristine graphene in experiments in a chicken embryo model

Sawosz E, Jaworski S, Kutwin M, Hotowy A, Wierzbicki M, Grodzik M, Kurantowicz N, Strojny B, Lipińska L, Chwalibog A

International Journal of Nanomedicine 2014, 9:3913-3922

Published Date: 14 August 2014

Noninvasive positive pressure ventilation in subjects with stable COPD: a randomized trial

Bhatt SP, Peterson MW, Wilson JS, Durairaj L

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:581-589

Published Date: 22 November 2013

Corrigendum

Seemungal TA, Lun JC, Davis G, Neblett C, Chinyepi N, Dookhan C, Drakes S, Mandeville E, Nana F, Setlhake S, King CP, Pinto Pereira L, Delisle J, Wilkinson TM, Wedzicha JA

International Journal of Chronic Obstructive Pulmonary Disease 2011, 6:385-386

Published Date: 4 July 2011