Home non-invasive mechanical ventilation use following acute hypercapnic respiratory failure in COPD. A solid protective factor

Respiratory Medicine xxx (2015) 1

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Home non-invasive mechanical ventilation use following acute hypercapnic respiratory failure in COPD. A solid protective factor

Keywords: Home non-invasive positive pressure ventilation Acute hypercapnic respiratory failure COPD

Dear Editor, Currently, home NPPV programs in COPD are still on debate and have conflictive results [1,2], so it is of utmost relevance to conduct studies clarifying this important issue. Galli JA et al. described positive effects of long term outcome in two acute exacerbation COPD cohorts in favor of NPPV use [3]. These results generate updated controversy regarding influence of NPPV after discharge; however, a more accurate assessment is needed for appropriate clinical extrapolations. 1. Patient selection method led to great population heterogeneity due to two main aspects: a) COPD diagnosis could be incorrect in some patients, regarding the ICD-9 code used and lacking of pulmonary function tests. b) There were significant comorbidities prevalence such as overlap with OHS and OSA, which may influence therapeutic responses. 2. Application and definition of bi-level NPPV during hospitalization needs clarification. It is not defined for how long it had to be used to include patients in the study. Hypercapnic respiratory failure is defined as PaCO2 >45 mm Hg, but it is unclear if this

was a nocturnal or diurnal value. Moreover, it seems that just one borderline value was enough to justify NPPV. 3. Other important issues to clarify are discharge aspects such as the criteria for home NPPV. Which patients have been ventilated and for what reason? What were the criteria for hospital readmission? Furthermore, readmission data and quality of life differences were not forwarded from physicians or hospitals but from the home institution's health care system. In conclusion, this work provides a valid enlightenment of the advantages of the NPPV programs following AECOPD, however further careful designed studies are needed.

References €rres, M. Pfeifer, Noninvasive home ventilation for chronic [1] S. Budweiser, R.A. Jo obstructive pulmonary disease: indications, utility and outcome, Curr. Opin. Pulm. Med. 14 (2) (2008 Mar) 128e134. [2] R.D. McEvoy, R.J. Pierce, D. Hillman, et al., Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial, Thorax 64 (7) (2009) 561e566. [3] J.A. Galli, J.S. Krahnke, A. James Mamary, K. Shenoy, H. Zhao, G.J. Criner, Home non-invasive ventilation use following acute hypercapnic respiratory failure in COPD, Respir. Med. 108 (5) (2014 May) 722e728.

P. Matos*, M.J. Kampelmacher, A.M. Esquinas Coimbra Hospital and University Center Coimbra, Portugal *

Corresponding author. Tel.: þ35 1916054167. E-mail address: [email protected] (P. Matos). Available online xxx

DOI of original article: http://dx.doi.org/10.1016/j.rmed.2014.03.006.

Abbreviations: COPD, chronic obstructive pulmonary disease; NPPV, non invasive positive pressure ventilation; AECOPD, acute exacerbation of COPD; ICD-9 code, international classification of diseases e 9; OSAS, obstructive sleep apnea syndrome; ICU, intensive care unit; OHS, obesity hypoventilation syndrome; OSA, obstructive sleep apnoea. http://dx.doi.org/10.1016/j.rmed.2015.07.001 0954-6111/© 2015 Elsevier Ltd. All rights reserved.

Please cite this article in press as: P. Matos, et al.Home non-invasive mechanical ventilation use following acute hypercapnic respiratory failure in COPD. A solid protective factor, Respiratory Medicine (2015), http://dx.doi.org/10.1016/j.rmed.2015.07.001