Résumé :
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Although non-invasive ventilation (NIV) is a validated approach to treat acute hypercapnia in COPD, the impact of its long term maintenance, following an acute exacerbation is poorly evaluated. NIV could be associated with a reduced frequency and length of hospitalization and an improvement of quality of life. The aim of the study was to prospectively investigate the effects of long term employment of NIV, following acute respiratory failure in severe COPD. 37 patients with acute hypercapnia (PaCO2=7.87 KPa, pH=7.36) were consecutively enrolled (inspiratory pressure ?16 cmH2O). After a one month period of adaptation and education in a weaning center, 2 groups were individualized : NIV compliant (> 5h/d, n=20) and NIV non-compliant patients (< 5h/d, n=17). Groups were statistically comparable for COPD severity, age, BMI, apnea-hypopnea index. The measured outcomes were focused on dyspnea, pulmonary function tests, frequency of COPD exacerbations, hospital and ICU admissions, St George's Hospital Questionnary (SGHQ), 6-min walk distance (6MWD) and survival. At 12 months, mortality was significantly higher in non-compliant group (40%vs 8%, p=0.02). In non-compliants, COPD exacerbations and frequency of hospitalizations were increased by 3 (p<0.05) and 5.5 (p<0.001) times respectively. SGHQ, 6 MWD and pulmonary function did not differ between groups. Our main results suggest that long term NIV for a selected group of COPD patients is effective in reducing mortality. However, additional controlled studies are required to confirm these preliminary results.
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