Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany.
Center for Pneumology and Thoracic Surgery, Lung Clinic Hemer, Hemer, Germany.
Sci Rep. 2023 Apr 21;13(1):6586. doi: 10.1038/s41598-023-33871-z.
The establishment of a guideline for long-term noninvasive ventilation treatment (LTH-NIV) of acute hypercapnic exacerbations of chronic obstructive pulmonary disease (AECOPD) requiring acute ventilation has proven elusive. Most studies thus far have shown no mortality benefit of long-term noninvasive ventilation treatment. Using retrospective analysis of the data of our patients (n = 143) recruited from 2012 to 2019, we aimed to compare patients discharged with and without long-term noninvasive ventilation. The follow-up results showed no significant difference (p = 0.233) between the groups [LTH-NIV (n = 83); non-NIV (n = 60)] regarding readmission due to clinical worsening. However, the first- and second-year survival rates were 82% and 72%, respectively, in the LTH-NIV group and significantly different (p = 0.023) from 67 and 55% in the non-NIV group. The statistical models showed a significant mortality risk for the non-NIV group, with a hazard ratio (HR) of 2.82 (1.31; 6.03). To the best of our knowledge, this is the first study to demonstrate the mortality benefit of long-term NIV therapy for patients with AECOPD under real-world conditions.
建立需要急性通气的慢性阻塞性肺疾病急性高碳酸血症加重（AECOPD）的长期无创通气治疗（LTH-NIV）指南一直难以实现。迄今为止，大多数研究都没有显示长期无创通气治疗的死亡率获益。我们通过对 2012 年至 2019 年期间招募的患者（n=143）的数据进行回顾性分析，旨在比较出院时使用和不使用长期无创通气的患者。随访结果显示，两组（LTH-NIV [n=83]；非-NIV [n=60]）因临床恶化再次入院的结果无显著差异（p=0.233）。然而，LTH-NIV 组的 1 年和 2 年生存率分别为 82%和 72%，明显高于非-NIV 组的 67%和 55%（p=0.023）。统计模型显示，非-NIV 组的死亡风险显著增加，风险比（HR）为 2.82（1.31；6.03）。据我们所知，这是第一项在真实世界条件下证明 AECOPD 患者长期 NIV 治疗具有生存获益的研究。
