Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.
Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA.
Clin Respir J. 2023 Aug;17(8):811-815. doi: 10.1111/crj.13678. Epub 2023 Jul 31.
The study objective was to estimate the prevalence of chronic hypercapnic respiratory failure (CHRF) and home noninvasive ventilation (NIV) use in a high-risk population, individuals with a history of at least one COPD-related hospitalizations.
We retrospectively analyzed electronic medical record data of patients with at least one COPD-related hospitalization between October 1, 2011, and September 30, 2017, to the Iowa City VA Medical Center. We excluded individuals with no obstructive ventilatory defect.
Of 186 patients, the overall prevalence of compensated hypercapnic respiratory failure (CompHRF), defined as PaCO > 45 mmHg with a pH = 7.35-7.45, was 52.7%, while the overall prevalence of home NIV was 4.3%. The prevalence of CompHRF was 43.6% and home NIV was 1.8% in those with one COPD-related hospitalization. Among those with ≥4 COPD-related hospitalizations, the prevalence of CompHRF was 77.8% (14 of 18), and home NIV was 11.1% (2 of 18).
Approximately half of individuals with at least one COPD-related hospitalization have CompHRF, but only 8.2% of those use home NIV. Future studies should estimate CHRF rates and the degree of underutilization of home NIV in larger multicenter samples.
本研究旨在评估高危人群（至少有一次 COPD 相关住院史的患者）中慢性高碳酸血症性呼吸衰竭（CHRF）和家庭无创通气（NIV）使用的患病率。
我们回顾性分析了 2011 年 10 月 1 日至 2017 年 9 月 30 日期间在爱荷华市退伍军人医疗中心至少有一次 COPD 相关住院史的患者的电子病历数据。我们排除了没有阻塞性通气缺陷的患者。
在 186 名患者中，代偿性高碳酸血症性呼吸衰竭（CompHRF）的总体患病率为 52.7%（定义为 PaCO2>45mmHg，同时 pH 值为 7.35-7.45），而家庭 NIV 的总体患病率为 4.3%。有一次 COPD 相关住院史的患者中 CompHRF 的患病率为 43.6%，家庭 NIV 的患病率为 1.8%。在有≥4 次 COPD 相关住院史的患者中，CompHRF 的患病率为 77.8%（18 例中有 14 例），家庭 NIV 的患病率为 11.1%（18 例中有 2 例）。
至少有一次 COPD 相关住院史的患者中约有一半存在 CompHRF，但仅有 8.2%的患者使用家庭 NIV。未来的研究应在更大的多中心样本中估计 CHRF 发生率和家庭 NIV 的未充分使用率。
