Investigation of COPD patients discharged without home mechanical ventilation after in-hospital use of acute non-invasive ventilation

Background: In stable hypercapnic COPD patients, clear benefits have been shown on long-term non-invasive positive pressure ventilation (NPPV) use, targeting reduction of hypercapnia. In contrast, the effectiveness of continuing NPPV at home after acute NPPV during hospitalization is controversial. Objectives: To evaluate the prognosis and clinical course of patients with COPD who used acute NPPV during hospitalization but not after discharge. Methods: We conducted a retrospective, single-center, chart review on patients admitted because of an acute exacerbation of COPD, who used NPPV during hospitalization between December 2010 and March 2014. Results: Eighteen patients continued using NPPV after discharge, while 7 patients did not. The average PaCO 2 on discharge was 62.0 mmHg in patients who used NPPV after discharge and 51.2 mmHg in patients who did not. Percentage of patients who developed an exacerbation after discharge was 61.0% and 42.9%, respectively. Median survival, event-free survival, and rate of acute exacerbation between the two groups were not significantly different. PaCO 2 -matched comparison revealed no significant difference in median survival and event-free survival between the patients with NPPV and without NPPV after discharge. Conclusion: COPD patients treated with acute NPPV in hospital did not continue NPPV after discharge when PaCO 2 got lower. In these patients prognosis was not significantly different from those with chronic NPPV. The doctors9 judgment of discontinuing NPPV when PaCO 2 has improved in hospital is feasible for COPD patients.