Researchers have found that the prolongation of noninvasive ventilation (NIV) for three nights after recovery from an episode of acute hypercapnic respiratory failure (AHRF) does not prevent subsequent relapse of AHRF in COPD patients without previous domiciliary ventilation.
The study is published today (6 July, 2017) in the European Respiratory Journal.
A randomised controlled trial was carried out with 120 COPD patients without previous domiciliary ventilation, who had been admitted for AHRF and treated with NIV. When the AHRF episode was resolved and patients could tolerate spontaneous breathing for four hours, they were randomly selected to receive nocturnal NIV for three more nights, or for discontinuation of NIV.
The researchers observed a shorter median stay in the intermediate respiratory care unit (IRCU) for the discontinuation group; however, no differences were observed in the main outcome of relapse of AHRF within eight days after NIV discontinuation.
Patients randomised to be treated with NIV for three consecutive nights after they reached clinical stability did not have a reduced occurrence of relapse versus patients who abruptly stopped using mechanical ventilation.
The authors conclude that prolonged continuation of nocturnal NIV after recovery from an AHRF episode does not prevent subsequent relapse of AHRF in COPD patients without previous domiciliary ventilation, but this may result in longer IRCU stay.
Based on these results, the authors suggest that NIV can be directly discontinued when the AHRF episode is resolved and patients are able to tolerate unassisted breathing.
Dr Stefano Nava and Dr Begum Ergan discuss the research in a new ERJ editorial, ‘I want to break free: liberation from noninvasive ventilation’, also published today.