Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation

Byline: Raffaele Scala (1), Sandra Bartolucci (2), Mario Naldi (1), Marcello Rossi (3), Mark W. Elliott (4) Keywords: Co-morbidities; Chronic obstructive pulmonary disease; Acute hypercapnic respiratory failure; Non-invasive positive pressure ventilation; Charlson index Abstract: Objective To assess the prevalence and the impact of chronic and/or acute non-respiratory co-morbidity on short and longer-term outcome of non-invasive positive pressure ventilation (NIPPV) in acute decompensations of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF). Design and setting An observational study in a three-bed respiratory monitoring unit in a respiratory ward of a non-university hospital. Patients We grouped 120 consecutive COPD patients requiring NIPPV for AHRF (pH 7.28+-0.05, PaO.sub.2/FIO.sub.2 ratio 192+-63, PaCO.sub.2 78.3+-12.3 mmHg) according to whether NIPPV succeeded (n=98) or failed (n=22) in avoiding the need for endotracheal intubation and whether alive (n=77) or dead (n=42) at 6 months. Measurements and results The prevalence of chronic and acute co-morbidity was, respectively, 20% and 41.7% most of the cases were cardiovascular. In-hospital NIPPV failure was greater in patients with than in those without chronic (33.3% vs. 14.6%) or acute co-morbidity (32% vs. 8.6%). Six-month mortality was worse in patients with than in those without chronic (54.2% vs. 30.5%) or more than one acute co-morbidity (66.7% vs. 30.8%). Multiple regression analysis predicted in-hospital NIPPV failure by acute co-morbidity and forced expiratory volume in 1 s, while death at 6 months was predicted by having more than one acute co-morbidity, non-cardiovascular chronic co-morbidity and Activities of Daily Living score. Conclusions Chronic and acute co-morbidities are common in COPD patients with AHRF needing NIPPV and their presence influences short and longer-term outcome. Author Affiliation: (1) U.O. Pneumologia, USL8, Ospedale S. Donato, Via Nenni 20, 52100, Arezzo, Italy (2) U.O. Sistema Informativo, Via Fonte Veneziana 16, 52100, Arezzo, Italy (3) U.O. Fisiopatologia e Riabilitazione Respiratoria, Azienda Ospedaliera Senese, Siena, Italy (4) Department of Respiratory Medicine, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK Article History: Registration Date: 11/06/2004 Received Date: 13/02/2004 Accepted Date: 01/06/2004 Online Date: 17/07/2004