Long-term survival following initiation of home non-invasive ventilation: a European study
Long-term survival following initiation of home non-invasive ventilation: a European study
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DOI：
10.1136/thoraxjnl-2019-214204
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发表时间：
2020-11-01
期刊：
影响因子：
10
通讯作者：
Hart, Nicholas
中科院分区：
文献类型：
--
作者：
Patout, Maxime;Lhuillier, Elodie;Hart, Nicholas
尽管家庭无创通气（NIV）越来越多地用于治疗慢性呼吸衰竭患者，但关于这些患者的长期预后的数据有限。我们的目的是报告来自两个欧洲中心的家庭NIV人群和长期结果。方法采用队列分析方法，纳入2008年至2014年来自欧洲两个中心的所有居家NIV患者。结果1746例患者采用家庭NIV治疗慢性呼吸衰竭(1)肥胖低通气综合征+/-阻塞性睡眠呼吸暂停（OHS +/- OSA） （29.5%）；(2)神经肌肉疾病（NMD） （22.7%）；(3)阻塞性气道疾病（OAD）（19.1%）。NIV启动后的总体队列中位生存期为6.6年。中位生存期因呼吸衰竭的潜在病因而异：快速进展的NMD 1.1年，OAD 2.7年，OHS +/- OSA bbb7年，缓慢进展的NMD bbb7年。多因素分析显示，快速进展的NMD（风险比4.78,95% CI 3.38至6.75）、COPD（风险比2.25,95% CI 1.64至3.10）、开始使用家庭NIV时的年龄（风险比2.41,95% CI 1.92至3.02）和急性入院后开始使用NIV的患者死亡率更高（风险比1.38,95% CI 1.13至1.68）。与低死亡率相关的因素是每天坚持使用NIV 4小时（HR 0.64, 95% CI 0.51 ~ 0.79）、OSA （HR 0.51, 95% CI 0.31 ~ 0.84）和女性（HR 0.79, 95% CI 0.65 ~ 0.96）。结论居家无创通气的死亡率较高，但因呼吸衰竭的病因不同而有显著差异。对于慢性呼吸衰竭患者，急性入院后开始使用家庭无创呼吸机和低水平的无创呼吸机依从性是预后不良的特征，可能需要干预。
Introduction Although home non-invasive ventilation (NIV) is increasingly used to manage patients with chronic ventilatory failure, there are limited data on the long-term outcome of these patients. Our aim was to report on home NIV populations and the long-term outcome from two European centres. Methods Cohort analysis including all patients established on home NIV from two European centres between 2008 and 2014. Results Home NIV was initiated in 1746 patients to treat chronic ventilatory failure caused by (1) obesity hypoventilation syndrome +/- obstructive sleep apnoea (OHS +/- OSA) (29.5%); (2) neuromuscular disease (NMD) (22.7%); and (3) obstructive airway diseases (OAD) (19.1%). Overall cohort median survival following NIV initiation was 6.6 years. Median survival varied by underlying aetiology of respiratory failure: rapidly progressive NMD 1.1 years, OAD 2.7 years, OHS +/- OSA >7 years and slowly progressive NMD >7 years. Multivariate analysis demonstrated higher mortality in patients with rapidly progressive NMD (HR 4.78, 95% CI 3.38 to 6.75), COPD (HR 2.25, 95% CI 1.64 to 3.10), age >60 years at initiation of home NIV (HR 2.41, 95% CI 1.92 to 3.02) and NIV initiation following an acute admission (HR 1.38, 95% CI 1.13 to 1.68). Factors associated with lower mortality were NIV adherence >4 hours per day (HR 0.64, 95% CI 0.51 to 0.79), OSA (HR 0.51, 95% CI 0.31 to 0.84) and female gender (HR 0.79, 95% CI 0.65 to 0.96). Conclusion The mortality rate following initiation of home NIV is high but varies significantly according to underlying aetiology of respiratory failure. In patients with chronic respiratory failure, initiation of home NIV following an acute admission and low levels of NIV adherence are poor prognostic features and may be amenable to intervention.