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• W2040543964 abstract "COPD is an irreversible disabling disease with increasing incidence worldwide. Patients with COPD frequently suffer in the end stage of the disease process from chronic hypercapnic respiratory failure (CHRF). Although high level of evidence has shown that adding noninvasive positive pressure ventilation (NIPPV) in addition to standard therapy with oxygen and medication is effective in the management of episodes of acute respiratory failure in patients with acute exacerbations of COPD,1Brochard L Mancebo J Wysocki M et al.Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.N Engl J Med. 1995; 333: 817-822Crossref PubMed Scopus (1702) Google Scholar the role of NIPPV on long-term survival in CHRF is still a topic of controversy despite the wide application of NIPVV in chronic hypercapnic patients.2Janssens JP Derivaz S Breitenstein E et al.Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area.Chest. 2003; 123: 67-79Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar3Leger P Bedicam JM Cornette A et al.Nasal intermittent positive pressure ventilation: long-term follow-up in patients with severe chronic respiratory insufficiency.Chest. 1994; 105: 100-105Abstract Full Text Full Text PDF PubMed Scopus (431) Google Scholar Prognostic parameters have not been evaluated under these conditions, although patients are at high risk for readmission and life-threatening events. The study by Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar in this issue of CHEST (see page 1650) evaluated prognostic markers of long-term survival in patients with severe COPD and CHRF receiving NIPVV. The study comprised a 10-year observation period, a mean follow-up of 32 months, and included 188 patients treated with NIPVV. The study pointed out that nutritional status assessed by body mass index (BMI), hyperinflation, and base excess (BE) independently predicted mortality. A reduction of these risk factors after initiation of NIPVV (increase in BMI in patients with BMI < 25 kg/m2; a decrease of residual volume [RV]/total lung capacity [TLC] by ≥ 4% in patients with RV/TLC ≥ 73% and a reduction in BE ≥ 50% if baseline BE is ≥ 9 mmol/L) was associated with improved survival.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google ScholarThe study of Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar confirms the important role of nutritional status in COPD. Previous work5Chailleux E Fauroux B Binet F et al.Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation: a 10-year analysis of ANTADIR Observatory.Chest. 1996; 109: 741-749Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar in patients with COPD, largely treated with long-term home oxygen therapy, have demonstrated that male gender, older age, lower BMI, FEV1 percentage of predicted, Pao2, and Paco2 were identified as independent negative prognostic factors. In another study6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar based on the ANTADIR observatory, it was demonstrated that the effect of BMI on survival was independent of age, FEV1, Pao2 and sex. Lower BMI was also a powerful predictor of duration and rate of hospitalization.6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar BMI in the study of Chailleux et al6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar was significantly lower than in the study by Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar: mean BMI, 23 kg/m2 vs 27.2 kg/m2. In the study by Chailleux et al,6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar 68.1% of the COPD patients had a BMI < 24 kg/m2. Studies7Vestbo J Prescott E Almdal T et al.Body mass, fat-free body mass and prognosis in COPD patients from a random population sample: findings from the Copenhagen City Heart Study.Am J Respir Crit Care Med. 2006; 173: 79-83Crossref PubMed Google Scholar8Schols AM Broekhuizen R Weling-Scheepers CA et al.Body composition and mortality in chronic obstructive pulmonary disease.Am J Clin Nutr. 2005; 82: 53-59Crossref PubMed Scopus (587) Google Scholar have reported that body composition assessment provides information in addition to BMI in different categories of COPD and that fat-free mass corrected for body surface is an independent predictor of mortality irrespective of fat mass in COPD. It would be interesting to evaluate in future studies body composition besides BMI in patients with chronic respiratory failure because depletion in fat-free mass can be found even in patients with normal or high BMI.9Kyle UG Janssens JP Rochat T et al.Body composition in patients with chronic hypercapnic respiratory failure.Respir Med. 2006; 100: 244-252Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar A BMI of 25 kg/m2, as used by Budweiser et al,4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar was reported by Schols et al10Schols AM Slangen J Volovics L et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1998; 157: 1791-1797Crossref PubMed Scopus (883) Google Scholar as a threshold value below which the mortality risk was clearly increased.In a large prospective study11Adams KF Schatzkin A Harris TB et al.Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.N Engl J Med. 2006; 355: 763-778Crossref PubMed Scopus (1698) Google Scholar cohort of persons of 50 to 71 years old, among all men and women, including smokers and those with preexisting disease, a U-shaped relation between current BMI and the risk of death was found, with the highest risk in the lowest and highest categories of BMI: a BMI between 23.5 kg/m2 and 24.9 kg/m2 was considered as the reference. These BMI cutoff values are markedly higher than arbitrarily defined in a multidimensional grading system for COPD.12Celli BR Cote CG Marin JM et al.The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.N Engl J Med. 2004; 350: 1005-1012Crossref PubMed Scopus (2984) Google Scholar In accordance with the prospective data of Schols et al10Schols AM Slangen J Volovics L et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1998; 157: 1791-1797Crossref PubMed Scopus (883) Google Scholar demonstrating that a gain in weight of 2 kg in depleted and nondepleted COPD patients was associated with an improvement of survival, Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar reported that an increase in body weight in patients with BMI < 25 kg/m2 resulted in an improved prognosis. Further studies have to explore minimally clinical important differences in BMI after intervention as well as the changes in body compartments after such interventions.Hyperinflation is reported as a second independent predictor of mortality in this population treated with NIPVV.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar The possible value of hyperinflation in predicting survival is poorly explored. Two studies10Schols AM Slangen J Volovics L et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1998; 157: 1791-1797Crossref PubMed Scopus (883) Google Scholar12Celli BR Cote CG Marin JM et al.The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.N Engl J Med. 2004; 350: 1005-1012Crossref PubMed Scopus (2984) Google Scholar using the percentage of normal inspiratory capacity (IC) and absolute IC failed to observe predictive capacity. However, by relating IC to TLC, a reflection of the functional reserve in COPD patients can be obtained. One study13Nishimura K Izumi T Tsukino M et al.Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD.Chest. 2002; 121: 1434-1440Abstract Full Text Full Text PDF PubMed Scopus (729) Google Scholar showed that hyperinflation expressed as the RV/TLC ratio was a powerful predictor of mortality in patients with COPD. Another study14Casanova C Cote C de Torres JP et al.Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2005; 171: 591-597Crossref PubMed Scopus (457) Google Scholar reported that the IC/TLC ratio is a good and independent predictor of all-cause and respiratory mortality; an IC/TLC threshold of 25% provided the best power. Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar used a cutoff value of RV/TLC ≥ 73%. Importantly, they could demonstrate that a reduction in RV/TLC by 4% in the most hyperinflated group resulted in a significant improvement of survival.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Further studies in COPD are needed to explore beneficial effects of lung deflation on survival in COPD.Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar also focused attention on the role of renal compensation in patients with persistently elevated carbon dioxide tension as a reduction in BE by > 42% was found as an independent predictor of mortality in patients showing BE ≥ 9 mmol/L.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Renal compensatory mechanisms are frequently overlooked in patients with chronic respiratory failure. Hypercapnia leads to a fall in renal perfusion, and this vasoconstrictor mechanism withstands vasodilatory stimuli. The vasoconstriction and sodium retention can be considered as restoring processes of the intravascular volume and tissue perfusion as carbon dioxide acts as a potent vasodilator and lowers peripheral vascular resistance and increases arterial capacity. Reduction in hypercapnia will attenuate compensating mechanisms and improve fluid homeostasis in patients with CRHF.15Wouters EF Management of severe COPD.Lancet. 2004; 364: 883-895Abstract Full Text Full Text PDF PubMed Scopus (72) Google ScholarComorbidity in COPD patients with CRHF is high, and overall prognosis is still poor, as illustrated by Budweiser et al.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Besides discussion of physiologic variables, it will be important to realize that an effective management for these patients need to be centered on adequate management of symptoms and maintenance of a reasonable quality of life. Honoring the treatment preferences of these severely disabled patients is crucial to the provision of high-quality care. Understanding of patient preferences depends on the assessment of how they view the burden of treatment to its possible outcomes and the likelihood of these outcomes. Further studies on NIPVV in COPD patients with CRHF will contribute to a better provision of information to these patients. NIPVV needs to be embedded in the multidimensional end-of-life management of the patients with very disabling COPD. COPD is an irreversible disabling disease with increasing incidence worldwide. Patients with COPD frequently suffer in the end stage of the disease process from chronic hypercapnic respiratory failure (CHRF). Although high level of evidence has shown that adding noninvasive positive pressure ventilation (NIPPV) in addition to standard therapy with oxygen and medication is effective in the management of episodes of acute respiratory failure in patients with acute exacerbations of COPD,1Brochard L Mancebo J Wysocki M et al.Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.N Engl J Med. 1995; 333: 817-822Crossref PubMed Scopus (1702) Google Scholar the role of NIPPV on long-term survival in CHRF is still a topic of controversy despite the wide application of NIPVV in chronic hypercapnic patients.2Janssens JP Derivaz S Breitenstein E et al.Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area.Chest. 2003; 123: 67-79Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar3Leger P Bedicam JM Cornette A et al.Nasal intermittent positive pressure ventilation: long-term follow-up in patients with severe chronic respiratory insufficiency.Chest. 1994; 105: 100-105Abstract Full Text Full Text PDF PubMed Scopus (431) Google Scholar Prognostic parameters have not been evaluated under these conditions, although patients are at high risk for readmission and life-threatening events. The study by Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar in this issue of CHEST (see page 1650) evaluated prognostic markers of long-term survival in patients with severe COPD and CHRF receiving NIPVV. The study comprised a 10-year observation period, a mean follow-up of 32 months, and included 188 patients treated with NIPVV. The study pointed out that nutritional status assessed by body mass index (BMI), hyperinflation, and base excess (BE) independently predicted mortality. A reduction of these risk factors after initiation of NIPVV (increase in BMI in patients with BMI < 25 kg/m2; a decrease of residual volume [RV]/total lung capacity [TLC] by ≥ 4% in patients with RV/TLC ≥ 73% and a reduction in BE ≥ 50% if baseline BE is ≥ 9 mmol/L) was associated with improved survival.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar The study of Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar confirms the important role of nutritional status in COPD. Previous work5Chailleux E Fauroux B Binet F et al.Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation: a 10-year analysis of ANTADIR Observatory.Chest. 1996; 109: 741-749Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar in patients with COPD, largely treated with long-term home oxygen therapy, have demonstrated that male gender, older age, lower BMI, FEV1 percentage of predicted, Pao2, and Paco2 were identified as independent negative prognostic factors. In another study6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar based on the ANTADIR observatory, it was demonstrated that the effect of BMI on survival was independent of age, FEV1, Pao2 and sex. Lower BMI was also a powerful predictor of duration and rate of hospitalization.6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar BMI in the study of Chailleux et al6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar was significantly lower than in the study by Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar: mean BMI, 23 kg/m2 vs 27.2 kg/m2. In the study by Chailleux et al,6Chailleux E Laaban JP Veale D Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR Observatory.Chest. 2003; 123: 1460-1466Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar 68.1% of the COPD patients had a BMI < 24 kg/m2. Studies7Vestbo J Prescott E Almdal T et al.Body mass, fat-free body mass and prognosis in COPD patients from a random population sample: findings from the Copenhagen City Heart Study.Am J Respir Crit Care Med. 2006; 173: 79-83Crossref PubMed Google Scholar8Schols AM Broekhuizen R Weling-Scheepers CA et al.Body composition and mortality in chronic obstructive pulmonary disease.Am J Clin Nutr. 2005; 82: 53-59Crossref PubMed Scopus (587) Google Scholar have reported that body composition assessment provides information in addition to BMI in different categories of COPD and that fat-free mass corrected for body surface is an independent predictor of mortality irrespective of fat mass in COPD. It would be interesting to evaluate in future studies body composition besides BMI in patients with chronic respiratory failure because depletion in fat-free mass can be found even in patients with normal or high BMI.9Kyle UG Janssens JP Rochat T et al.Body composition in patients with chronic hypercapnic respiratory failure.Respir Med. 2006; 100: 244-252Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar A BMI of 25 kg/m2, as used by Budweiser et al,4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar was reported by Schols et al10Schols AM Slangen J Volovics L et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1998; 157: 1791-1797Crossref PubMed Scopus (883) Google Scholar as a threshold value below which the mortality risk was clearly increased. In a large prospective study11Adams KF Schatzkin A Harris TB et al.Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.N Engl J Med. 2006; 355: 763-778Crossref PubMed Scopus (1698) Google Scholar cohort of persons of 50 to 71 years old, among all men and women, including smokers and those with preexisting disease, a U-shaped relation between current BMI and the risk of death was found, with the highest risk in the lowest and highest categories of BMI: a BMI between 23.5 kg/m2 and 24.9 kg/m2 was considered as the reference. These BMI cutoff values are markedly higher than arbitrarily defined in a multidimensional grading system for COPD.12Celli BR Cote CG Marin JM et al.The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.N Engl J Med. 2004; 350: 1005-1012Crossref PubMed Scopus (2984) Google Scholar In accordance with the prospective data of Schols et al10Schols AM Slangen J Volovics L et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1998; 157: 1791-1797Crossref PubMed Scopus (883) Google Scholar demonstrating that a gain in weight of 2 kg in depleted and nondepleted COPD patients was associated with an improvement of survival, Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar reported that an increase in body weight in patients with BMI < 25 kg/m2 resulted in an improved prognosis. Further studies have to explore minimally clinical important differences in BMI after intervention as well as the changes in body compartments after such interventions. Hyperinflation is reported as a second independent predictor of mortality in this population treated with NIPVV.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar The possible value of hyperinflation in predicting survival is poorly explored. Two studies10Schols AM Slangen J Volovics L et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1998; 157: 1791-1797Crossref PubMed Scopus (883) Google Scholar12Celli BR Cote CG Marin JM et al.The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.N Engl J Med. 2004; 350: 1005-1012Crossref PubMed Scopus (2984) Google Scholar using the percentage of normal inspiratory capacity (IC) and absolute IC failed to observe predictive capacity. However, by relating IC to TLC, a reflection of the functional reserve in COPD patients can be obtained. One study13Nishimura K Izumi T Tsukino M et al.Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD.Chest. 2002; 121: 1434-1440Abstract Full Text Full Text PDF PubMed Scopus (729) Google Scholar showed that hyperinflation expressed as the RV/TLC ratio was a powerful predictor of mortality in patients with COPD. Another study14Casanova C Cote C de Torres JP et al.Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2005; 171: 591-597Crossref PubMed Scopus (457) Google Scholar reported that the IC/TLC ratio is a good and independent predictor of all-cause and respiratory mortality; an IC/TLC threshold of 25% provided the best power. Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar used a cutoff value of RV/TLC ≥ 73%. Importantly, they could demonstrate that a reduction in RV/TLC by 4% in the most hyperinflated group resulted in a significant improvement of survival.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Further studies in COPD are needed to explore beneficial effects of lung deflation on survival in COPD. Budweiser et al4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar also focused attention on the role of renal compensation in patients with persistently elevated carbon dioxide tension as a reduction in BE by > 42% was found as an independent predictor of mortality in patients showing BE ≥ 9 mmol/L.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Renal compensatory mechanisms are frequently overlooked in patients with chronic respiratory failure. Hypercapnia leads to a fall in renal perfusion, and this vasoconstrictor mechanism withstands vasodilatory stimuli. The vasoconstriction and sodium retention can be considered as restoring processes of the intravascular volume and tissue perfusion as carbon dioxide acts as a potent vasodilator and lowers peripheral vascular resistance and increases arterial capacity. Reduction in hypercapnia will attenuate compensating mechanisms and improve fluid homeostasis in patients with CRHF.15Wouters EF Management of severe COPD.Lancet. 2004; 364: 883-895Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar Comorbidity in COPD patients with CRHF is high, and overall prognosis is still poor, as illustrated by Budweiser et al.4Budweiser S Jörres R Riedl T et al.Predictors of survival in chronic hypercapnic patients with COPD undergoing non-invasive home ventilation.Chest. 2007; 131: 1650-1658Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Besides discussion of physiologic variables, it will be important to realize that an effective management for these patients need to be centered on adequate management of symptoms and maintenance of a reasonable quality of life. Honoring the treatment preferences of these severely disabled patients is crucial to the provision of high-quality care. Understanding of patient preferences depends on the assessment of how they view the burden of treatment to its possible outcomes and the likelihood of these outcomes. Further studies on NIPVV in COPD patients with CRHF will contribute to a better provision of information to these patients. NIPVV needs to be embedded in the multidimensional end-of-life management of the patients with very disabling COPD." @default.
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• W2040543964 title "Decision Making in Chronic Hypercapnic Respiratory Failure" @default.
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