https://doi.org/10.4081/monaldi.2023.2755

Comparison of immediate withdrawal and stepwise reduction in duration of non-invasive ventilation in chronic obstructive pulmonary disease patients presenting with acute hypercapnic respiratory failure

Early Access
Submitted: August 27, 2023
Accepted: September 27, 2023
Published: October 12, 2023
COPD, NIV, weaning
Abstract Views: 609
PDF_early view: 292
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Authors

Swetabh Purohit
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Manu Madan
https://orcid.org/0000-0001-9245-4568
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Rohit Kumar
https://orcid.org/0000-0001-6398-7840
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Rajnish Kaushik
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Pranav Ish
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Mahendran AJ
https://orcid.org/0000-0003-4907-1312
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Shibdas Chakrabarti
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Neeraj Kumar Gupta
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Nitesh Gupta
niteshgupta2107@gmail.com
https://orcid.org/0000-0002-5842-5584
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

There is no universally acceptable protocol for the withdrawal of non-invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients presenting with acute hypercapnic respiratory failure (AHcRF). This study was carried out to evaluate immediate against stepwise reduction in NIV. Sixty COPD patients with AHcRF who were managed with NIV were randomized into two groups - immediate NIV withdrawal (Group A), and stepwise reduction of NIV duration (Group B). The rate of successful NIV withdrawal, time to recurrence of hypercapnic respiratory failure, total duration of NIV use, and hospital length of stay (LOS), were compared among the 2 groups. NIV was successfully withdrawn in 51/60 (85%) patients. NIV was successfully withdrawn in 24/30 (80%) patients in Group A and 27/30 (90%) patients in Group B (p=0.472). The total duration of NIV use was significantly lower in Group A (38.97±17 hours) as compared to Group B (64.3±7.74 hours) (p<0.0001). The hospital LOS was significantly lower in group A (5.8±1.6 days) as compared to Group B (7.7±0.61 days) (p<0.0001). To conclude, immediate withdrawal of the NIV after recovery of respiratory failure among patients with exacerbation of COPD is feasible and does not increase the risk of weaning failure.

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Europe PMC
Duan J, Tang X, Huang S, et al. Protocol-directed versus physician-directed weaning from noninvasive ventilation: The impact in chronic obstructive pulmonary disease patients. J Trauma Acute Care Surg 2012;72:1271–5. DOI: https://doi.org/10.1097/TA.0b013e318249a0d5
Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50:1602426. DOI: https://doi.org/10.1183/13993003.02426-2016
Lightowler JV, Wedzicha JA, Elliott MW, Ram FSF. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003;326:185-7. DOI: https://doi.org/10.1136/bmj.326.7382.185
Soo Hoo GW, Santiago S, Williams AJ. Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med 1994;22:1253-61. DOI: https://doi.org/10.1097/00003246-199408000-00009
Nava S, Ambrosino N, Clini E, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. Pneumologie 1999;53:246.
Antón A, Güell R, Gómez J, et al. Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation. Chest 2000;117:828-33. DOI: https://doi.org/10.1378/chest.117.3.828
Damas C, Andrade C, Araújo JP, et al. Weaning from non-invasive positive pressure ventilation: Experience with progressive periods of withdraw. Rev Port Pneumol 2008;14:49-53. DOI: https://doi.org/10.1016/S2173-5115(09)70243-X
Venkatnarayan K, Khilnani G, Hadda V, et al. A comparison of three strategies for withdrawal of noninvasive ventilation in chronic obstructive pulmonary disease with acute respiratory failure: Randomized trial. Lung India 2020;37:3-7. DOI: https://doi.org/10.4103/lungindia.lungindia_335_19
Sellares J, Ferrer M, Anton A, et al. Discontinuing noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations: A randomised controlled trial. Eur Respir J 2017;50:1601448. DOI: https://doi.org/10.1183/13993003.01448-2016
Adler D, Perrig S, Takahashi H, et al. Polysomnography in stable COPD under non-invasive ventilation to reduce patient-ventilator asynchrony and morning breathlessness. Sleep Breath 2012;16:1081-90. DOI: https://doi.org/10.1007/s11325-011-0605-y

Ethics Approval

The study was approved by Institutional Ethics Committee of Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi

How to Cite

Purohit, Swetabh, Manu Madan, Rohit Kumar, Rajnish Kaushik, Pranav Ish, Mahendran AJ, Shibdas Chakrabarti, Neeraj Kumar Gupta, and Nitesh Gupta. 2023. “Comparison of Immediate Withdrawal and Stepwise Reduction in Duration of Non-Invasive Ventilation in Chronic Obstructive Pulmonary Disease Patients Presenting With Acute Hypercapnic Respiratory Failure”. Monaldi Archives for Chest Disease, October. https://doi.org/10.4081/monaldi.2023.2755.
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