Home noninvasive ventilatory support for patients with chronic obstructive pulmonary disease: patient selection and perspectives

Jan Hendrik Storre,1,2 Jens Callegari,3 Friederike Sophie Magnet,3 Sarah Bettina Schwarz,3 Marieke Leontine Duiverman,4,5 Peter Jan Wijkstra,4,5 Wolfram Windisch3 1Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany; 2Department of Pneumology, University Medical Hospital, Freiburg, Germany; 3Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany; 4Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 5Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands Abstract: Long-term or home mechanical noninvasive ventilation (Home-NIV) has become a well-established form of therapy over the last few decades for chronic hypercapnic COPD patients in European countries. However, meta-analyses and clinical guidelines do not recommend Home-NIV for COPD patients on a routine basis. In particular, there is ongoing debate about Home-NIV in chronic hypercapnic COPD regarding the overall effects, the most favorable treatment strategy, the selection of eligible patients, and the time point at which it is prescribed. The current review focuses on specific aspects of patient selection and discusses the various scientific as well as clinical-guided perspectives on Home-NIV in patients suffering from chronic hypercapnic COPD. In addition, special attention will be given to the topic of ventilator settings and interfaces. Keywords: exacerbation, pulmonary emphysema, hypercapnia, mechanical ventilation, respiratory insufficienc

Capillary PO2 does not adequately reflect arterial PO2 in hypoxemic COPD patients

Friederike Sophie Magnet,1 Daniel Sebastian Majorski,1 Jens Callegari,1 Sarah Bettina Schwarz,1 Claudia Schmoor,2 Wolfram Windisch,1 Jan Hendrik Storre3,4 1Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany; 2Clinical Trials Unit, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; 3Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany; 4Department of Pneumology, University Medical Hospital, Freiburg, Germany Purpose: To compare arterial (PaO2) with capillary (PcO2) partial pressure of oxygen in hypoxemic COPD patients because capillary blood gas analysis (CBG) is increasingly being used as an alternative to arterial blood gas analysis (ABG) in a non-intensive care unit setting, although the agreement between PcO2 and PaO2 has not been evaluated in hypoxemic COPD patients.Patients and methods: Bland–Altman comparison of PaO2 and PcO2 served as the primary outcome parameter if PcO2 values were ≤60 mmHg and the secondary outcome parameter if PcO2 values were ≤55 mmHg. Pain associated with the measurements was assessed using a 100-mm visual analog scale.Results: One hundred and two PaO2/PcO2 measurement pairs were obtained. For PcO2 values ≤60 mmHg, the mean difference between PaO2 and PcO2 was 5.99±6.05 mmHg (limits of agreement: -5.88 to 17.85 mmHg). For PcO2 values ≤55 mmHg (n=73), the mean difference was 5.33±5.52 mmHg (limits of agreement: -5.48 to 16.15 mmHg). If PaO2 ≤55 (≤60) mmHg was set as the cut-off value, in 20.6% (30.4%) of all patients, long-term oxygen therapy have been unnecessarily prescribed if only PcO2 would have been assessed. ABG was rated as more painful compared with CBG.Conclusions: PcO2 does not adequately reflect PaO2 in hypoxemic COPD patients, which can lead to a relevant number of unnecessary long-term oxygen therapy prescriptions. Keywords: blood gas analysis, COPD, respiratory insufficiency, hypoxemi