Department of Pulmonary Diseases and Home Mechanical Ventilation.
Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Curr Opin Support Palliat Care. 2023 Dec 1;17(4):277-282. doi: 10.1097/SPC.0000000000000671. Epub 2023 Aug 23.
The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this review, the authors summarize the evidence for nocturnal NIV and NIV during exercise. The authors discuss the multidisciplinary and advanced care of patients with end-stage COPD treated with NIV.
Nocturnal NIV improves gas exchange, health-related quality of life and survival in stable hypercapnic COPD patients. Improvements in care delivery have been achieved by relocating care from the hospital to home based; home initiation of chronic NIV is feasible, non-inferior regarding efficacy and cost-effective compared to in-hospital initiation. However, the effect of NIV on symptoms is variable, and applying optimal NIV for end-stage COPD is complex. While exercise-induced dyspnoea is a prominent complaint in end-stage COPD, nocturnal NIV will not change this. However, NIV applied solely during exercise might improve exercise tolerance and dyspnoea. While chronic NIV is often a long-standing treatment, patient expectations should be discussed early and be managed continuously during the treatment. Further, integration of advance care planning requires a multidisciplinary approach.
Although chronic NIV is an effective treatment in end-stage COPD with persistent hypercapnia, there are still important questions that need to be answered to improve care of these severely ill patients.
接受慢性无创通气（NIV）治疗的终末期慢性阻塞性肺疾病（COPD）患者数量大大增加。在本次综述中，作者总结了夜间 NIV 和运动时 NIV 的证据。作者讨论了接受 NIV 治疗的终末期 COPD 患者的多学科和高级护理。
夜间 NIV 可改善稳定型高碳酸血症 COPD 患者的气体交换、健康相关生活质量和生存率。通过将护理从医院转移到家庭，实现了护理提供的改进；在家中开始慢性 NIV 是可行的，在疗效和成本效益方面不劣于住院起始。然而，NIV 对症状的影响是可变的，为终末期 COPD 应用最佳的 NIV 较为复杂。虽然运动引起的呼吸困难是终末期 COPD 的突出症状，但夜间 NIV 不会改变这一点。然而，仅在运动时应用 NIV 可能会改善运动耐量和呼吸困难。虽然慢性 NIV 通常是一种长期治疗，但应尽早讨论患者的期望，并在治疗过程中持续管理。此外，需要采用多学科方法来整合临终关怀计划。
虽然慢性 NIV 是持续性高碳酸血症的终末期 COPD 的有效治疗方法，但仍有许多重要问题需要解决，以改善这些重症患者的护理。
