PaCO2 Six months after the Initiation of Long-term Noninvasive Ventilation in Patients with COPD

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Author(s)

    • Tsuboi Tomomasa
    • Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Japan|Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan
    • Chin Kazuo
    • Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Japan
    • Oga Toru
    • Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Japan
    • Machida Kazuko
    • Department of Respiratory Medicine, National Tokyo Hospital, Japan
    • Sumi Kensuke
    • Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan
    • Oguri Susumu
    • Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan
    • Sato Atsuo
    • Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan
    • Kurasawa Takuya
    • Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan

Abstract

<b>Background and Objective</b> The appropriate target level for PaCO<sub>2</sub> after the introduction of long-term noninvasive positive pressure ventilation (NPPV) in patients with COPD remains uncertain, and therefore must be tested.<br> <b>Methods</b> Data on 54 patients with COPD receiving long-term domiciliary NPPV were examined retrospectively. PaCO<sub>2</sub> a few months after NPPV and potential confounders were analyzed with discontinuation of long-term NPPV as the primary outcome. The differences in annual hospitalization rates due to respiratory deterioration between those from 1 year before to 2 years after initiation of NPPV were compared according to the PaCO<sub>2</sub> measured at 6 months after NPPV (6-mo PaCO<sub>2</sub>).<br> <b>Results</b> 6-mo PaCO<sub>2</sub> seemed to be most related to continuation of NPPV (p=0.019). Patients with 6-mo PaCO<sub>2</sub> of less than 60 mmHg had maintained a significantly lower PaCO<sub>2</sub> value 6 to 24 months after NPPV (p=0.04) and had a significantly higher continuation rate of NPPV (p=0.03) than those with a 6-mo PaCO<sub>2</sub> of 60 mmHg or more. Annual hospitalization rates due to respiratory deterioration were not associated with the 6-mo PaCO<sub>2</sub> level, but fatal hospitalization rates during the first year of NPPV were significantly correlated with relatively high 6-mo PaCO<sub>2</sub> (p=0.008).<br> <b>Conclusion</b> A relatively low 6-mo PaCO<sub>2</sub> value was predictive of long-term use of NPPV. The target values of 6-mo PaCO<sub>2</sub> may, therefore, be less than 60 mmHg in COPD patients with extremely severe hypercapnia, although more prospective studies are needed.<br>

Journal

  • Internal Medicine

    Internal Medicine 50(6), 563-570, 2011

    The Japanese Society of Internal Medicine

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