Thomas Audrey, Jaffré Sandrine, Guardiolle Vianney, Perennec Tanguy, Gagnadoux Frédéric, Goupil François, Bretonnière Cédric, Danielo Vivien, Morin Jean, Blanc François-Xavier
Nantes Université, CHU Nantes, Department of Respiratory Medicine, l'institut du thorax, Nantes, France.
Nantes Université, CHU Nantes, Data Clinic, INSERM CIC 1413, Nantes, France.
Heliyon. 2024 Feb 18;10(4):e26437. doi: 10.1016/j.heliyon.2024.e26437. eCollection 2024 Feb 29.
Non-invasive ventilation (NIV) improves survival of patients with chronic respiratory failure (CRF). Most often, pressure settings are made to normalize arterial blood gases. However, this objective is not always achieved due to intolerance to increased pressure or poor compliance. Few studies have assessed the effect of persistent hypercapnia on ventilated patients' survival. Data from the Pays de la Loire Respiratory Health Research Institute cohort were analyzed to answer this question.
NIV-treated adults enrolled between 2009 and 2019 were divided into 5 subgroups: obesity-hypoventilation syndrome (OHS), COPD, obese COPD, neuromuscular disease (NMD) and chest wall disease (CWD). PaCO correction was defined as the achievement of a PaCO < 6 kPa or a 20% decrease in baseline PaCO₂ in COPD patients. The endpoint was all-cause mortality. Follow-up was censored in case of NIV discontinuation.
Data from 431 patients were analyzed. Median survival was 103 months and 148 patients died. Overall, PaCO correction was achieved in 74% of patients. Bivariate analysis did not show any survival difference between patients who achievedPaCO₂ correction and those who remained hypercapnic: overall population: p = 0.74; COPD: p = 0.97; obese COPD: p = 0.28; OHS: p = 0.93; NMD: p = 0.84; CWD: p = 0.28.
Moderate residual hypercapnia under NIV does not negatively impact survival in CRF patients. In individuals with poor tolerance of pressure increases, residual hypercapnia can therefore be tolerated under long-term NIV. Larger studies, especially with a higher number of patients with residual PaCO > 7 kPa, are needed to confirm these results.
无创通气（NIV）可提高慢性呼吸衰竭（CRF）患者的生存率。大多数情况下，压力设置旨在使动脉血气正常化。然而，由于对压力增加不耐受或依从性差，这一目标并不总是能够实现。很少有研究评估持续性高碳酸血症对接受通气治疗患者生存的影响。分析了卢瓦尔河地区呼吸健康研究所队列的数据以回答这个问题。
2009年至2019年期间接受NIV治疗的成年患者被分为5个亚组：肥胖低通气综合征（OHS）、慢性阻塞性肺疾病（COPD）、肥胖型COPD、神经肌肉疾病（NMD）和胸壁疾病（CWD）。PaCO₂校正定义为COPD患者的PaCO₂<6kPa或基线PaCO₂降低20%。终点为全因死亡率。若NIV中断，则随访终止。
分析了431例患者的数据。中位生存期为103个月，148例患者死亡。总体而言，74%的患者实现了PaCO₂校正。双变量分析未显示实现PaCO₂校正的患者与仍存在高碳酸血症的患者之间存在任何生存差异：总体人群：p = 0.74；COPD：p = 0.97；肥胖型COPD：p = 0.28；OHS：p = 0.93；NMD：p = 0.84；CWD：p = 0.28。
NIV治疗下的中度残余高碳酸血症对CRF患者的生存没有负面影响。因此，在压力增加耐受性差的个体中，长期NIV治疗下可耐受残余高碳酸血症。需要更大规模的研究，尤其是纳入更多残余PaCO₂>7kPa患者的研究来证实这些结果。
