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NIV for acute respiratory failure in COPD: high in-hospital mortality is determined by patient selection

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@article{676a7ad5f3124957819d3739d7b998c5,
title = "NIV for acute respiratory failure in COPD: high in-hospital mortality is determined by patient selection",
abstract = "Introduction: Hospital mortality among chronic obstructive pulmonary disease (COPD) patients receiving NIV for acute respiratory failure has shown to be significantly higher in clinical settings than in the randomized trials (RCTs) which clinical guidelines are based on. This may be due to the quality of care of NIV or patient selection. In daily clinical practice, we include patients with terminal pulmonary disease with a do-not-intubate (DNI) or a do-not-resuscitate (DNR) order with a high mortality risk compared to highly selected patients in RCTs. The aim of this study was to determine the role of patient selection for in-hospital mortality among patients receiving NIV for acute respiratory failure of COPD. Methods: We conducted a retrospective study including all patients receiving acute NIV due to acute respiratory failure at the respiratory wards in 2012-2013 at two hospitals in Greater Copenhagen. Results: Overall in-hospital mortality rate was 30{\%}. In patients with a DNI/DNR order, mortality was 59{\%} and in patients with no limitations in treatment 2{\%}. Patients who fulfilled the exclusion criteria of the RCT by Plant et al. had a mortality of 41{\%} compared to 25{\%} in the remaining population. Conclusions: High overall in-hospital mortality reflects that patient selection in clinical practice is very different from RCT. Quality of acute NIV treatment seems acceptable in clinical practice for patients with less severe COPD and no limitations in treatment. Higher mortality in patients with DNI/DNR order may be due to inefficient NIV treatment for these patients with more severe COPD.",
author = "Caroline Hedsund and Ankj{\ae}rgaard, {Kasper Linde} and Rasmussen, {Daniel Bech} and Schwaner, {Signe H{\o}yer} and Andreassen, {Helle Frost} and Hansen, {Ejvind Frausing} and Wilcke, {Jon Torgny}",
year = "2019",
month = "1",
doi = "10.1080/20018525.2019.1571332",
language = "English",
volume = "6",
pages = "1571332",
journal = "European Clinical Respiratory Journal",
issn = "2001-8525",
publisher = "Co-Action Publishing",
number = "1",

}

RIS

TY - JOUR

T1 - NIV for acute respiratory failure in COPD

T2 - high in-hospital mortality is determined by patient selection

AU - Hedsund, Caroline

AU - Ankjærgaard, Kasper Linde

AU - Rasmussen, Daniel Bech

AU - Schwaner, Signe Høyer

AU - Andreassen, Helle Frost

AU - Hansen, Ejvind Frausing

AU - Wilcke, Jon Torgny

PY - 2019/1

Y1 - 2019/1

N2 - Introduction: Hospital mortality among chronic obstructive pulmonary disease (COPD) patients receiving NIV for acute respiratory failure has shown to be significantly higher in clinical settings than in the randomized trials (RCTs) which clinical guidelines are based on. This may be due to the quality of care of NIV or patient selection. In daily clinical practice, we include patients with terminal pulmonary disease with a do-not-intubate (DNI) or a do-not-resuscitate (DNR) order with a high mortality risk compared to highly selected patients in RCTs. The aim of this study was to determine the role of patient selection for in-hospital mortality among patients receiving NIV for acute respiratory failure of COPD. Methods: We conducted a retrospective study including all patients receiving acute NIV due to acute respiratory failure at the respiratory wards in 2012-2013 at two hospitals in Greater Copenhagen. Results: Overall in-hospital mortality rate was 30%. In patients with a DNI/DNR order, mortality was 59% and in patients with no limitations in treatment 2%. Patients who fulfilled the exclusion criteria of the RCT by Plant et al. had a mortality of 41% compared to 25% in the remaining population. Conclusions: High overall in-hospital mortality reflects that patient selection in clinical practice is very different from RCT. Quality of acute NIV treatment seems acceptable in clinical practice for patients with less severe COPD and no limitations in treatment. Higher mortality in patients with DNI/DNR order may be due to inefficient NIV treatment for these patients with more severe COPD.

AB - Introduction: Hospital mortality among chronic obstructive pulmonary disease (COPD) patients receiving NIV for acute respiratory failure has shown to be significantly higher in clinical settings than in the randomized trials (RCTs) which clinical guidelines are based on. This may be due to the quality of care of NIV or patient selection. In daily clinical practice, we include patients with terminal pulmonary disease with a do-not-intubate (DNI) or a do-not-resuscitate (DNR) order with a high mortality risk compared to highly selected patients in RCTs. The aim of this study was to determine the role of patient selection for in-hospital mortality among patients receiving NIV for acute respiratory failure of COPD. Methods: We conducted a retrospective study including all patients receiving acute NIV due to acute respiratory failure at the respiratory wards in 2012-2013 at two hospitals in Greater Copenhagen. Results: Overall in-hospital mortality rate was 30%. In patients with a DNI/DNR order, mortality was 59% and in patients with no limitations in treatment 2%. Patients who fulfilled the exclusion criteria of the RCT by Plant et al. had a mortality of 41% compared to 25% in the remaining population. Conclusions: High overall in-hospital mortality reflects that patient selection in clinical practice is very different from RCT. Quality of acute NIV treatment seems acceptable in clinical practice for patients with less severe COPD and no limitations in treatment. Higher mortality in patients with DNI/DNR order may be due to inefficient NIV treatment for these patients with more severe COPD.

U2 - 10.1080/20018525.2019.1571332

DO - 10.1080/20018525.2019.1571332

M3 - Journal article

VL - 6

SP - 1571332

JO - European Clinical Respiratory Journal

JF - European Clinical Respiratory Journal

SN - 2001-8525

IS - 1

ER -

ID: 56497454