Ribeiro Carla, Jácome Cristina, Oliveira Pedro, Luján Manuel, Conde Sara
Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal.
Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine University of Porto, Porto, Portugal.
ERJ Open Res. 2024 Sep 30;10(5). doi: 10.1183/23120541.00125-2024. eCollection 2024 Sep.
Home mechanical ventilation (HMV) is indicated in patients with severe hypercapnic COPD. Initiation of HMV commonly occurs during an inpatient period, but there has been increasing interest for outpatient adaptation. This study aimed to evaluate the outpatient initiation and adaptation of HMV and its impact on health-related quality of life (HRQoL) in patients with severe COPD.
A single-group pre-test-post-test study was conducted in an outpatient ventilation clinic of a tertiary hospital in Portugal. Patients with severe COPD and symptoms of chronic respiratory failure with daytime partial pressure of carbon dioxide ( ) ≥50 mmHg in a stable condition or with persistent hypercapnia ≥53 mmHg >14 days following an exacerbation with mechanical ventilation were included. After 3 months of HMV, patients completed the severe respiratory insufficiency (SRI), the S3-noninvasive ventilation (S3-NIV) and a patient experience questionnaire.
53 patients (73.6% male, median 71 (p25-p75 61-77) years), with a median forced expiratory volume in 1 s of 35 (29-40)% and a median baseline of 53.5 (51.9-56.5) mmHg completed the study. At 3 months patients had a median HMV usage of 6.5 h and decreased their by 6.0 mmHg. After 3 months, there was a significant improvement in the SRI summary scale (+5.7), above the minimal clinically import difference of five. Patients who used HMV for more than 5 h had higher S3-NIV total score (6.8 5.7, p=0.04) and S3-NIV sleep and NIV-related side effects subscore (7.1 5.7, p=0.03).
Our findings might indicate that outpatient initiation and adaptation of HMV has a positive impact in short-term HRQoL in patients with COPD and that this approach is perceived as a positive experience by the patients.
家庭机械通气（HMV）适用于重度高碳酸血症慢性阻塞性肺疾病（COPD）患者。HMV通常在住院期间开始使用，但门诊适应性应用越来越受到关注。本研究旨在评估重度COPD患者门诊启动和适应HMV及其对健康相关生活质量（HRQoL）的影响。
在葡萄牙一家三级医院的门诊通气诊所进行了单组前后测试研究。纳入重度COPD且有慢性呼吸衰竭症状、稳定状态下白天二氧化碳分压（ ）≥50 mmHg或机械通气加重后持续高碳酸血症≥53 mmHg超过14天的患者。HMV治疗3个月后，患者完成严重呼吸功能不全（SRI）、S3无创通气（S3-NIV）和患者体验问卷。
53例患者（男性占73.6%，年龄中位数71（25%-75%分位数为61-77）岁）完成了研究，其1秒用力呼气容积中位数为35（29-40）%，基线 中位数为53.5（51.9-56.5）mmHg。3个月时患者HMV使用时间中位数为6.5小时， 下降了6.0 mmHg。3个月后，SRI总分有显著改善（提高5.7分），高于最小临床重要差异5分。使用HMV超过5小时的患者S3-NIV总分（6.8 5.7，p = 0.04）以及S3-NIV睡眠和NIV相关副作用子评分（7.1 5.7，p = 0.03）更高。
我们的研究结果可能表明，门诊启动和适应HMV对COPD患者的短期HRQoL有积极影响，并且患者认为这种方法是一种积极的体验。
