Introduction

It remains unclear whether long-term non-invasive ventilation (LT NIV) for patients with chronic obstructive pulmonary disease (COPD) improves survival and reduces admissions as results from randomized trials are inconsistent. We aim to determine whether LT NIV initiated after an admission with acute hypercapnic respiratory failure (AHRF), can affect survival and admission rate in COPD patients.

Methods

A randomized controlled trial, allocating patients to LT NIV or standard of care after an admission with AHRF treated with acute NIV. The LT NIV provided was aimed to normalize PaCO2 using high pressures.

Results

The study was conducted in 2013-2020 and discontinued before full sample size due to slow recruitment. 28 patients were randomized to LT NIV and 27 patients to standard of care. 42% of patients had a history of ?2 admissions with AHRF. Median IPAP was 24 cmH2O (IQR 20-28). The primary outcome, time to readmission with AHRF or death within 12 months, did not reach significance, hazard ratio 0.53 (95%CI 0.25-1.12) p=0.097. In a competing risk analysis, adjusted for history of AHRF, the odds ratio for AHRF was 0.30 (95%CI 0.11-0.87) p=0.024. The LT NIV group had fewer exacerbations (median 1 (0-1) vs 2 (1-4) p=0.021) and readmissions with AHRF (median 0 (0-1) vs 1 (0-1) p=0.016).  

Conclusion

No effect on the primary outcome was found, however several secondary outcomes like risk of AHRF, number of episodes of AHRF and exacerbations were all in favor of high intensity LT NIV, especially in selected COPD patients with frequent AHRF.