8(th) International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F.; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A.; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

There is limited evidence to support the provision of NPPV in the home environment after successful treatment of acute hypercapnic respiratory failure in COPD patients. However, those studies supporting this intervention had limitations, including small sample size, retrospective nature, and a lack of control group. Struik et al. [58] evaluated whether home NPPV after successfully treated acute respiratory failure reduces re-hospitalization and improves survival. The investigators randomized patients to home NPPV or standard treatment 48 h after "acute" ventilator support was terminated. The study failed to show a positive effect of home NPPV on time to readmission or death. This was not anticipated and stands in clear contrast to the smaller studies published before. Looking deeper into the study it can be seen that both groups had reductions in PaCO 2 over time. Therefore, one explanation of why this multicenter study was negative was the fact that patients were randomized too early: given the natural course of the disease, patients might have been randomized while they were still recovering from acute hypercapnia. Therefore, home NPPV might have been prescribed to patients not suffering from chronic hypercapnia. This study underscores the importance of carefully selecting patients for home NPPV.