Dreher - Figure 38

Correspondence Re: Study Pt. Selection

The null benefit for time-to-readmission or death and the equal lowering of PaCO2 values in both the HMV and the standard treatment groups[18] might be because these patients, who were randomized due to prolonged hypercapnia >48 h after termination of ventilatory support, represented a mixed cohort, with both acute-on-chronic and acute respiratory failure.[19]  

Therefore in future studies it may be of interest to select patients with persistent hypercapnia several weeks after the acute exacerbation episode, in order to include only patients with acute-on-chronic respiratory failure, as it may be this group who benefits from HMV after acute respiratory failure.

Dreher M. Chest 2017:00.

References

[18]

Struik FM, Sprooten RT, Kerstjens HAM, et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomized, controlled, parallel-group study. Thorax. 2014;69:826−34. doi: 10.1136/thoraxjnl-2014- 205126.

[19]

Borel JC, Pison C, Timsit JF, Pepin JL. Domiciliary long-term non-invasive ventilation in COPD: should we select subgroups with a better likelihood to respond to NIV in subsequent randomised controlled trials? Thorax. 2014;69:1143. doi: 10.1136/thoraxjnl-2014- 205949.