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https://hdl.handle.net/2440/58766
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Type: | Journal article |
Title: | Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial |
Author: | McEvoy, R. Pierce, R. Hillman, D. Esterman, A. Ellis, E. Catcheside, P. O'Donoghue, F. Barnes, D. Grunstein, R. |
Citation: | Thorax, 2009; 64(7):561-566 |
Publisher: | British Med Journal Publ Group |
Issue Date: | 2009 |
ISSN: | 0040-6376 1468-3296 |
Statement of Responsibility: | R D McEvoy, R J Pierce, D Hillman, A Esterman, E E Ellis, P G Catcheside, F J O’Donoghue, D J Barnes, R R Grunstein, on behalf of the Australian trial of noninvasive Ventilation in Chronic Airflow Limitation (AVCAL) Study Group |
Abstract: | Background: Sleep hypoventilation has been proposed as a cause of progressive hypercapnic respiratory failure and death in patients with severe chronic obstructive pulmonary disease (COPD). A study was undertaken to determine the effects of nocturnal non-invasive bi-level pressure support ventilation (NIV) on survival, lung function and quality of life in patients with severe hypercapnic COPD. Method: A multicentre, open-label, randomised controlled trial of NIV plus long-term oxygen therapy (LTOT) versus LTOT alone was performed in four Australian University Hospital sleep/respiratory medicine departments in patients with severe stable smoking-related COPD (forced expiratory volume in 1 s (FEV1.0) ,1.5 litres or ,50% predicted and ratio of FEV1.0 to forced vital capacity (FVC) ,60% with awake arterial carbon dioxide tension (PaCO2) .46 mm Hg and on LTOT for at least 3 months) and age ,80 years. Patients with sleep apnoea (apnoea-hypopnoea index .20/h) or morbid obesity (body mass index .40) were excluded. Outcome measures were survival, spirometry, arterial blood gases, polysomnography, general and disease-specific quality of life and mood. Results: 144 patients were randomised (72 to NIV + LTOT and 72 to LTOT alone). NIV improved sleep quality and sleep-related hypercapnia acutely, and patients complied well with therapy (mean (SD) nightly use 4.5 (3.2) h). Compared with LTOT alone, NIV (mean follow-up 2.21 years, range 0.01–5.59) showed an improvement in survival with the adjusted but not the unadjusted Cox model (adjusted hazard ratio (HR) 0.63, 95% CI 0.40 to 0.99, p=0.045; unadjusted HR 0.82, 95% CI 0.53 to 1.25, p=NS). FEV1.0 and PaCO2 measured at 6 and 12 months were not different between groups. Patients assigned to NIV + LTOT had reduced general and mental health and vigour. Conclusions: Nocturnal NIV in stable oxygen-dependent patients with hypercapnic COPD may improve survival, but this appears to be at the cost of worsening quality of life. |
Keywords: | Australian trial of non-invasive Ventilation in Chronic Airflow Limitation (AVCAL) Study Group Humans Pulmonary Disease, Chronic Obstructive Hypercapnia Carbon Dioxide Forced Expiratory Volume Treatment Outcome Positive-Pressure Respiration Survival Analysis Affect Partial Pressure Quality of Life Aged Female Male |
Rights: | Copyright status unknown |
DOI: | 10.1136/thx.2008.108274 |
Published version: | http://dx.doi.org/10.1136/thx.2008.108274 |
Appears in Collections: | Aurora harvest 5 Molecular and Biomedical Science publications |
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