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Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

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journal contribution
posted on 12.08.2019, 10:46 by A Jayadev, R Stone, M Steiner, V McMillan, M Roberts
Background Randomised control trial (RCT)-derived survival figures for acute exacerbation of chronic obstructive pulmonary disease admissions managed with non-invasive ventilation (NIV) have not been replicated in UK clinical audits. Subsequent guidelines have emphasised the need for timely NIV application. Methods Data from the 2008 and 2014 national chronic obstructive pulmonary disease audits was used to analyse the association between time to NIV and mortality Results 1032 patients received NIV in 2008, and 1612 in 2014. Overall mortality rates reduced between the audits from 24.9% in 2008 to 16.8% in 2014 but time to NIV lengthened. In 2014, 20.9% of patients received NIV within 60 min versus 24.9% in 2008 (p=0.001). The proportion of patients receiving NIV between 3 and 24 hours increased from 31.3% in 2008 to 39% in 2014 (p=0.001). Patients admitted with hypercapnic acidotic respiratory failure who received NIV within 3 hours had lower in-patient mortality than those who received NIV between 3 and 24 hours, 15.9% versus 18.4%, but this did not reach statistical significance (p=0.425), but acidotic patients receiving NIV >24 hours after admission had significantly higher mortality (28.9%, p=0.002). A second cohort admitted with hypercapnia but normal range pH, who developed later acidosis, had higher mortality (24.6%), compared with those acidotic on admission (18% p≤0.001) and an extremely high mortality when NIV was given >24 hours after admission (42.6%). Conclusion Survival rates for those treated with NIV has improved between the two audits but remains lower than reported in RCTs. Patients who developed acidosis after admission and received NIV later in the hospital stay have even higher mortality and deserve further study and clinical attention.

Funding

The National COPD audit programme was funded by NHS England and the Welsh Government via the Healthcare Quality Improvement Partnership. However, no funding was received for the analysis and writing of this article.

History

Citation

BMJ Open Respiratory Research, 2019, 6:e000444.

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

VoR (Version of Record)

Published in

BMJ Open Respiratory Research

Publisher

BMJ Publishing Group

issn

2052-4439

Acceptance date

02/07/2019

Copyright date

2019

Available date

12/08/2019

Publisher version

https://bmjopenrespres.bmj.com/content/6/1/e000444

Notes

Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/bmjresp-2019-000444) Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

Language

en

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