P196 Outcome of COPD patients started on inpatient domiciliary NIV following an acute admission with hypercapnic respiratory failure

Shere, C, Dalton, C, Oldham, J and Dushianthan, A (2019) P196 Outcome of COPD patients started on inpatient domiciliary NIV following an acute admission with hypercapnic respiratory failure. Thorax, 74 (2). (doi:10.1136/thorax-2019-btsabstracts2019.339).

Abstract

Background Recurrent hypercapnic exacerbations of COPD place a significant burden on hospitals. GOLD guidelines recognise domiciliary NIV as beneficial for selected COPD patients hospitalised with acute hypercapnic respiratory failure (AHRF), especially with persistent PaCO2>7kpa. A recent study demonstrated that domiciliary NIV conferred a reduction in composite outcomes of 12-month readmission and mortality in COPD patients following hospital admission.1 Methods Data collected retrospectively for 162 admissions to the Respiratory High Dependency Unit (RHDU) with AHRF COPD exacerbations in 2017, representing 132 patients. We collected clinical information from all available hospital electronic resources. Results Mean age was 70.6 years, with a mean FEV1 of 37.4%. 24% of patients admitted were discharged with domiciliary NIV, of which 11.4% was newly initiated. Newly initiated patients (N=15) were slightly younger with more LTOT use. They had higher PaCO2 on admission and responded well to acute inpatient NIV. 73% (N=11/15) had PaCO2>7kPa at the time of NIV initiation. This group had a 12-month mortality of 40% and readmission rate of 0.7 episodes/12 months. Additional 36 patients were discharged from RHDU with persistent PaC02>7Kpa, without domiciliary NIV initiation. This group had a 12-month mortality of 30%, with readmission rates comparable with the domiciliary NIV- initiated group. However, there were deficiencies in follow-up plans with lack of repeat routine arterial blood gas (ABG) analysis for these patients compared to the NIV-initiated group. Conclusions Following an AHRF admission, COPD patients with established respiratory failure have significant mortality even at 12-months, despite inpatient domiciliary NIV initiation. However, this group may represent patients with severe illness, who may be unable to wean off NIV completely. We identified a group of patients who could have been started on domiciliary NIV as recommended by GOLD guidelines. We found low rates of follow-up ABG analysis for those who had PaCO2>7kPa during admission. We are currently developing a screening tool to ensure appropriate follow-up with repeat ABG measurements to assess potential suitability for domiciliary NIV.

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Contributors

Author: A Dushianthan

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