Temporal trends in survival following ward-based NIV for acute hypercapnic respiratory failure in patients with COPD

Samuel Trethewey, Ross Edgar, Julien Morlet, Rahul Mukherjee, Alice Turner

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Introduction: Non-invasive ventilation (NIV) is recommended for treatment of acute hypercapnic respiratory failure (AHRF) refractory to medical management in patients with acute exacerbations of COPD. National UK audit data suggests that mortality rates are rising in COPD patients treated with NIV.

Objective: To investigate temporal trends in in-hospital mortality in COPD patients undergoing a first episode of ward-based NIV for AHRF.

Methods: Retrospective study of hospitalised COPD patients treated with a first episode of wardbased NIV at a large UK teaching hospital between 2004 to 2017. Patients were split into two cohorts based on year of admission, 2004-2010 (Cohort 1) and 2013-2017 (Cohort 2), to facilitate comparison of patient characteristics and in-hospital mortality.

Results: In total, 547 unique patients were studied. There was no difference in in-hospital mortality rate between the time periods studied (17.6% vs. 20.5%, p=0.378). In Cohort 2 there were more females, a higher rate of co-morbid bronchiectasis and a higher rate of pneumonia on admission , higher rate of co-morbid bronchiectasisand more severe acidosis, hypercapnia and hypoxia. , More patients in Cohort 2 had greater proportion of patients with NIV as the ceiling of treatment. Patients in Cohort 2 experienced a, longer time from AHRF diagnosis to application of NIV, higher maximum inspiratory positive airway pressure, lower maximum oxygen and, shorter duration of NIV. ,Finally, patients in Cohort 2 experienced a shorter hospital length of stay (LOS), with no differences observed in rate of transfer to critical care or intubation. in hospital and more severe acidosis, hypercapnia and hypoxia.

Conclusion: In-hospital mortality remained stable and LOS decreased over time, despite greater comorbidity and more severe AHRF in COPD patients treated for the first time with ward-based NIV for AHRF. This study highlights a need for evaluation of factors influencing clinician decisions to manage patients with concomitant pneumonia and severe AHRF with ward-based NIV.

Key words: chronic obstructive pulmonary disease; acute exacerbation; acute hypercapnic respiratory failure; non-invasive ventilation; trends; survival; mortality.
Original languageEnglish
Pages (from-to)184-188
Number of pages5
JournalThe Clinical Respiratory Journal
Issue number3
Publication statusPublished - 12 Jan 2019


  • chronic obstructive pulmonary disease
  • acute exacerbation
  • acute hypercapnic respiratory failure
  • non-invasive ventilation
  • trends
  • survival
  • mortality


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