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 (31.0 9.6) % Paco 2 (56.3 9.4) mm Hg1994 72004 7 (NIV)Cox (BMI) NIV (6.7 2.8) mo (32.2 24.3) 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 www.chestjournal.org.cn CHEST 2007 12 4 12 771
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-93093 Donaustauf, Germany; e-mail: stephan.budweiser@klinik.uniregensburg.de NPPV CHRF NPPVCOPD NPPV NPPV 1994 72001 12 NPPV COPD 2002 1 2004 7 12 mo FEV 1 / (VC) 70%NPPV Paco 2 ( mm Hg) Paco 2 (45 mm Hg) NPPV ( ) [27] NPPV 772
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 / 188 64.5 8.0 65.0 65 0.000 4 0.417 2 0.230 7 0.655 0 BMI / kg m -2 188 27.2 6.9 27.2 27 0.000 1 5.077 6 2.928 0 8.203 7 BMI / kg m -2(3) 188 25 0.000 1 4.311 2 2.916 6 8.475 2 / 188 41 / 147 0.335 7 1.371 7 0.737 7 2.439 4 / 188 59 / 129 0.228 7 0.733 5 0.418 4 1.231 6 /g dl -1 188 14.7 2.1 14.8 15 0.006 3 2.027 0 1.219 9 3.354 7 / 10 3 µl -1 188 9.6 3.6 9.1 9 0.162 0 0.701 8 0.423 5 1.154 6 CRP / mg dl -1 182 23.5 46.1 5.3 5 0.899 1 1.032 7 0.614 7 1.739 9 sraw / kpa s -1 185 5.2 3.0 4.5 4.5 0.001 6 0.440 8 0.260 4 0.730 3 IC / TLC / % 185 19.9 8.1 18.5 19 0.000 1 3.931 9 2.170 3 6.078 6 RV / TLC / % 185 72.0 9.5 73.3 73 0.000 1 0.317 0 0.183 1 0.521 3 FEV 1 /L 185 0.85 0.31 0.78 0.8 0.006 1 2.039 5 1.224 7 3.392 7 FEV 1 /% 185 31.0 9.6 30.0 30 0.020 8 1.745 7 1.053 0 2.905 9 FEV 1 /VC/% 185 46.7 11.1 46.0 46 0.119 7 1.496 9 0.900 5 2.489 8 ph 177 7.40 0.04 7.40 7.40 0.000 2 0.388 1 0.205 5 0.610 2 Pao 2 / mm Hg 177 58.2 16.6 56.0 56 0.737 3 0.916 4 0.544 1 1.538 5 Paco 2 / mm Hg 177 56.3 9.3 56.0 56 0.358 8 0.786 8 0.467 4 1.317 2 BE / mmol L -1 177 8.8 0.5 8.6 9 0.000 4 0.398 6 0.229 3 0.658 1 (1) x _ s (26.6%) (1.3 1.2) L (2) Kaplan-Meier ( ) (3) Chailleux [5] Schols [33] www.chestjournal.org.cn CHEST 2007 12 4 12 773
2 (n = 116) (1) (2) (3) (4) P BMI / kg m -2 28.3 7.1 28.1 6.7 114 0.243 /g dl -1 15.1 2.1 13.8 1.7 116 0.001 / 10 3 µl -1 8.6 2.5 8.9 2.9 116 0.263 sraw / kpa s -1 5.0 2.6 4.6 2.8 110 0.025 IC / TLC / % 20.1 8.3 21.9 9.2 110 0.031 RV/TLC/% 71.1 9.4 68.2 10.5 110 0.001 FEV 1 / L 0.89 0.34 1.04 0.44 110 0.001 FEV 1 /% 31.7 10.2 37.7 14.6 110 0.001 FEV 1 /VC/% 46.9 11.5 47.5 10.3 110 0.511 ph 7.41 0.04 7.42 0.03 105 0.001 Pao 2 /mm Hg 57.7 17.4 60.5 11.8 105 0.021 Paco 2 /mm Hg 56.1 8.7 45.4 6.9 105 0.001 BE / mmol L -1 8.5 4.2 4.7 4.1 105 0.001 (1) x _ s (2) (1.2 1.1) L (0.9 1.1) L (3) NPPV (6.7 2.8) mo (4) Shapiro-Wilk t Mann-Whitney U Wilcoxon Kaplan-Meier NPPV 2004 7 31 Cox P 0.05 0.10 P 0.05 (SPSS version 11.0 SPSS Chicago IL) 305 COPDNPPV 65 52 12 mo 188 ( 1) 59 (31.4%) BE (P 0.05) 3 ( Cox ) (1) β SE Exp (β) Exp (β) 95%CI P / 65.0 0.766 0.295 2.152 1.207 3.836 0.009 BMI / kg m -2 25.0 0.975 0.371 0.377 0.182 0.781 0.009 RV / TLC / % 73.0 0.990 0.425 2.690 1.169 6.190 0.020 BE / mmol L -1 9.0 0.679 0.305 1.972 1.085 3.584 0.026 (1) Exp (β): 774
100 100 100 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 0 60 120 0 60 120 0 60 120 t /mo BMI 25 kg / m 2 RV / TLC 73% BE 9mmol/L 106 72 45 23 10 4 1 93 55 30 19 7 0 0 83 46 22 8 3 2 0 BMI 25 kg / m 2 RV / TLC 73% BE 9mmol/L 82 43 13 5 2 0 0 91 59 38 20 9 4 1 94 65 35 20 9 2 1 1 BMI (A P 0.000 1) RV / TLC (B P 0.000 1) BE (C P 0.000 4) Kaplan-Meier CRP (P 0.001) (P = 0.002) BMI (P 0.05) (n = 129) EPAP (4.0 1.7) cm H 2 O IPAP (19.5 4.4) cm H 2 O (20.3 4.1) /min (43.6%) (23.4%) (36.2%) (10.1%)β ( ) (73%) / (56%) (68%) 74% (n =188) NPPVNPPV (32.2 24.3) mo 13 (6.9%) NPPV 2 (1.1%) 44.7% (n = 84) 1 2 5y 84.0% (n = 158 / 188 95%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 =62 73.8%) (n =22) (n =8) (n = 5) NPPV (n = 129) 12 1 116 NPPV (6.7 2.8) mo ( P 0.05) ( 2) NPPV (6.5 2.5) h / d (n =98 84.5%) ( 1 ) (n =3) 53 (63.1%) / (n =70 83.4%) (n =14 16.6%) BMI (sraw) (RV) / (TLC) (IC) / TLC FEV 1 ph BE ( 1) (P = 0.819) () IPAP www.chestjournal.org.cn CHEST 2007 12 4 12 775
100 100 100 A BMI BMI B RV / TLC 4% RV / TLC 4% C BE mmol / L BE mmol / L 0 40 80 0 40 80 0 60 120 t/mo BMI 47 30 11 4 2 0 BMI 21 11 2 1 0 0 RV / TLC 4% 40 28 13 5 1 0 RV / TLC 4% 33 23 5 3 1 0 BE mmol / L 46 31 16 6 2 1 0 BE mmol / L 29 16 6 2 1 1 0 2 A BMI 25 kg / m 2 (n =68 P = 0.028 9) NPPV BMI Kaplan-Meier B RV / TLC 73% (n =73 P = 0.034 1) RV / TLC 4.0% 4.0% (3.9%) Kaplan-Meier C BE 9 mmol / L (n =75 P = 0.015 0) 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 = 0.0289 2A) RV / TLC 73% RV / TLC 4.0% (3.9%) (n =73 P = 0.034 1 2B) COPD BE NPPV Paco 2 BE CHRF COPD NPPV BE 9 mmol / L (n =75 P = 0.015 0 P = 0.005 9) BE % (.5%) ( 2C) 42% ( 33) 90NPPV COPD [31] [15 32] 776
[26] 10 y 32 mo NPPVCOPD COPD BMI [4 5 7 8] 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 2 48.8 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] www.chestjournal.org.cn CHEST 2007 12 4 12 777
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