CHEST COPD COPD (CHRF) COPD. (prognostic factors) BE = base excess; BMI = body mass index; CHRF = chronic hypercapnic respiratory

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1 CHEST COPD COPD Stephan Budweiser, MD; Rudolf A. Jörres, PhD; Theresa Riedl; Frank Heinemann, MD; André P. Hitzl; Wolfram Windisch, MD; and Michael Pfeifer, MD (CHRF) COPD 188 COPD FEV 1 ( ) % Paco 2 ( ) mm Hg (NIV)Cox (BMI) NIV ( ) mo ( ) mo 44.7% 1 2 5y 84.0% 65.3% 26.4% (73.8%) BMI FEV 1 (RV) / (TLC) ph (BE) ( P 0.01) BMI RV / TLC BE (P 0.05) (BMI 25 kg /m 2 RV / TLC 73% BE 9 mmol / L) CHRF COPD BE CHRF NIV (chronic respiratory failure); (COPD); (mortality); (noninvasive ventilation); (prognostic factors) BE = base excess; BMI = body mass index; CHRF = chronic hypercapnic respiratory CHEST

2 failure; CI = confidence interval; CRP = C-reactive protein; EPAP = expiratory positive airway pressure; HR = hazard ratio; IC = inspiratory capacity; IPAP = inspiratory positive airway pressure; LTOT = long-term oxygen therapy; NPPV = noninvasive positive pressure ventilation; RV = residual volume; sraw = specific airway resistance; TLC = total lung capacity; VC = vital capacity COPD [1] COPD [2 3] FEV 1 [4 6] (BMI) [7 8] [8] (CHRF) [4 9 10] (LTOT) [11 13] Paco 2 (BE) CHRF [14] CHRF COPD (NPPV) [15] [16 23] NPPV CHRF [24] [25 26] From the Center for Pneumology (Drs. Budweiser and Heinemann, Ms. Riedl, and Mr. Hitzl), Donaustauf Hospital, Donaustauf; Institute and Outpatient Clinic for Occupational and Environmental Medicine (Dr. Jrres), Ludwig-Maximilians- University, Munich; Department of Pneumology (Dr. Windisch), University Hospital Freiberg, Freiberg; and Department of Internal Medicine II (Dr. Pfeifer), University of Regensburg, Regensburg, Germany. Correspondence to: Stephan Budweiser, MD, Klinik Donaustauf, Zentrum für Pneumologie, Ludwigstraβe 68, D Donaustauf, Germany; stephan.budweiser@klinik.uniregensburg.de NPPV CHRF NPPVCOPD NPPV NPPV NPPV COPD mo FEV 1 / (VC) 70%NPPV Paco 2 ( mm Hg) Paco 2 (45 mm Hg) NPPV ( ) [27] NPPV 772

3 NPPV [28 29] 1 C (CRP) (Micro 60- CT ABX Montpellier France and Dimension Xpand Dade Behring Schwalbach Germany) BMI (kg / m 2 ) NPPV NPPV (IPAP) 10 ml / kg () Paco 2 20% (EPAP) [30] 90% 10 Onyx plus (Nellcor Puritan Bennett Courtaboef Cedex France) BIPAP synchrony ST (Respironics Murrysville PA) Twin Air (Airox Pau France) NPPV 6mo NPPV 1 () (1) P (2) HR 95% CI / BMI / kg m BMI / kg m -2(3) / / / / /g dl / 10 3 µl CRP / mg dl sraw / kpa s IC / TLC / % RV / TLC / % FEV 1 /L FEV 1 /% FEV 1 /VC/% ph Pao 2 / mm Hg Paco 2 / mm Hg BE / mmol L (1) x _ s (26.6%) ( ) L (2) Kaplan-Meier ( ) (3) Chailleux [5] Schols [33] CHEST

4 2 (n = 116) (1) (2) (3) (4) P BMI / kg m /g dl / 10 3 µl sraw / kpa s IC / TLC / % RV/TLC/% FEV 1 / L FEV 1 /% FEV 1 /VC/% ph Pao 2 /mm Hg Paco 2 /mm Hg BE / mmol L (1) x _ s (2) ( ) L ( ) L (3) NPPV ( ) mo (4) Shapiro-Wilk t Mann-Whitney U Wilcoxon Kaplan-Meier NPPV Cox P P 0.05 (SPSS version 11.0 SPSS Chicago IL) 305 COPDNPPV mo 188 ( 1) 59 (31.4%) BE (P 0.05) 3 ( Cox ) (1) β SE Exp (β) Exp (β) 95%CI P / BMI / kg m RV / TLC / % BE / mmol L (1) Exp (β): 774

5 BMI 25 kg / m 2 RV / TLC 73% BMI 25 kg / m 2 RV / TLC 73% BE 9mmol/L BE 9mmol/L A B C t /mo BMI 25 kg / m 2 RV / TLC 73% BE 9mmol/L BMI 25 kg / m 2 RV / TLC 73% BE 9mmol/L BMI (A P ) RV / TLC (B P ) BE (C P ) Kaplan-Meier CRP (P 0.001) (P = 0.002) BMI (P 0.05) (n = 129) EPAP ( ) cm H 2 O IPAP ( ) cm H 2 O ( ) /min (43.6%) (23.4%) (36.2%) (10.1%)β ( ) (73%) / (56%) (68%) 74% (n =188) NPPVNPPV ( ) mo 13 (6.9%) NPPV 2 (1.1%) 44.7% (n = 84) 1 2 5y 84.0% (n = 158 / %CI 69.3% 96.3%) 65.3% (n = 98 / 1 95%CI 49.5% 82.8%) 26.4% (n =28/106 95%CI 16.5% 42.2%) (n = %) (n =22) (n =8) (n = 5) NPPV (n = 129) NPPV ( ) mo ( P 0.05) ( 2) NPPV ( ) h / d (n = %) ( 1 ) (n =3) 53 (63.1%) / (n = %) (n = %) BMI (sraw) (RV) / (TLC) (IC) / TLC FEV 1 ph BE ( 1) (P = 0.819) () IPAP CHEST

6 A BMI BMI B RV / TLC 4% RV / TLC 4% C BE mmol / L BE mmol / L t/mo BMI BMI RV / TLC 4% RV / TLC 4% BE mmol / L BE mmol / L A BMI 25 kg / m 2 (n =68 P = ) NPPV BMI Kaplan-Meier B RV / TLC 73% (n =73 P = ) RV / TLC 4.0% 4.0% (3.9%) Kaplan-Meier C BE 9 mmol / L (n =75 P = ) BE % % (.5%) Kaplan-Meier EPAP Cox BMI RV / TCL BE (P 0.05 RV / TLC BMIBE 9 mmol / L (n =84 P = 0.011) BE 42% 3) BMI RV / TLC BE 1 NPPV CHRF NPPV BMI 25 kg / m 2 BMI (n =68 P = A) RV / TLC 73% RV / TLC 4.0% (3.9%) (n =73 P = B) COPD BE NPPV Paco 2 BE CHRF COPD NPPV BE 9 mmol / L (n =75 P = P = ) BE % (.5%) ( 2C) 42% ( 33) 90NPPV COPD [31] [15 32] 776

7 [26] 10 y 32 mo NPPVCOPD COPD BMI [ ] 25 kg / m 2 [5 33] BMI 20 kg / m 2 COPD BMI [7 34] COPD [30 35] BMI 25 kg / m 2 CHRF NPPV [30] [36] IC / TLC RV / TLC COPD [37] [38] FEV 1 RV / TLC 73% [39] NPPV [16 17] [40] COPD Paco 2 [4] [12] ( 45 mm Hg) ( 45 mm Hg) LTOT Paco 2 55 mm Hg 1 [4] [41 42] [43] BE Paco 2 BE CHRF Paco 2 COPD (Paco mm Hg BE 3.6 mmol / L)BE [13] BE Paco 2 BE [14] BE [44] [45] [46] BE (n = 139) BE (P =0.01) NPPV 6 mo Paco 2 BE BE 9mmol/L BE 42% % BE BE BE NPPV CHRF BE % Pao 2 LTOT LTOT COPD [9 10] CHEST

8 [27] [41 42] CRP NPPV [47] CHRF COPD BE Paco 2 CHRF BE BMI NPPV CHRF COPD 1 Mannino DM. Semin Respir Crit Care Med 2005;26: Dolan S, et al. Curr Opin Pulm Med 2005;11: Oga T, et al. Am J Respir Crit Care Med 2003;167: Chailleux E, et al. Chest 1996;109: Chailleux E, et al. Chest 2003;123: Wouters EF. Thorax 2002;57: Vestbo J, et al. Am J Respir Crit Care Med 2006;173: Celli BR, et al. N Engl J Med 2004;3: Nocturnal Oxygen Therapy Trial Group. Ann Intern Med 1980; 93: Report of the Medical Research Council Working Party. Lancet 1981;1: Cooper CB, et al. Thorax 1987;42: Aida A, et al. Am J Respir Crit Care Med 1998;158: Nizet TA, et al. Chest 2005;127: Grant BJB, et al. Respiratory functions of the lung.in: Baum GL, et al, eds. Textbook of pulmonary diseases. New York: Lippincott Williams and Wilkins,1993; Janssens JP, et al. Chest 2003;123: Budweiser S, et al. Respir Med 2005;99: Diaz O, et al. Eur Respir J 2002;20: Elliott MW, et al. Thorax 1992;47: Jones SE, et al. Thorax 1998;53: Meecham Jones DJ, et al. Am J Respir Crit Care Med 1995; 152: Sivasothy P, et al. Eur Respir J 1998;11: Windisch W, et al. Chest 2005;128: Criner GJ, et al. Chest 1999;116: Wijkstra PJ, et al. Chest 2003;124: Tuggey JM, et al. Thorax 2003;58: Chu CM, et al. Thorax 2004;59: Anthonisen NR, et al. Ann Intern Med 1987;106: American Thoracic Society. Am J Respir Crit Care Med 1995; 152: Quanjer PH, et al. Eur Respir J Suppl 1993;16: Budweiser S, et al. Respir Care 2006;51: Lloyd-Owen SJ, et al. Eur Respir J 2005;25: Leger P, et al. Chest 1994;105: Schols AM, et al. Am J Respir Crit Care Med 1998;157: Schols AM, et al. Am J Clin Nutr 2005;82: Cano NJ, et al. Eur Respir J 2002;20: Schols A. Proc Nutr Soc 2003;62: Casanova C, et al. Am J Respir Crit Care Med 2005;171: Martinez FJ, et al. Am J Respir Crit Care Med 2006;173: van Noord JA, et al. Chest 2006;129: Casaburi R, et al. Proc Am Thorac Soc 2006;3: Seneff MG, et al. JAMA 1995;274: Connors AF Jr, et al. Am J Respir Crit Care Med 1996;154: Costello R, et al. Am J Med 1997;102: Hukins CA, et al. Am J Respir Crit Care Med 2000;161: Weitzenblum E, et al. Sleep Med Rev 2004;8: Effros RM, et al. Philadelphia, PA: Elsevier Books Oxford, 2005; Plant PK, et al. Lancet 2000;355: CHEST 2007;131:

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