PaCO2 Six months after the Initiation of Long-term Noninvasive Ventilation in Patients with COPD
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概要
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Background and Objective The appropriate target level for PaCO2 after the introduction of long-term noninvasive positive pressure ventilation (NPPV) in patients with COPD remains uncertain, and therefore must be tested. Methods Data on 54 patients with COPD receiving long-term domiciliary NPPV were examined retrospectively. PaCO2 a few months after NPPV and potential confounders were analyzed with discontinuation of long-term NPPV as the primary outcome. The differences in annual hospitalization rates due to respiratory deterioration between those from 1 year before to 2 years after initiation of NPPV were compared according to the PaCO2 measured at 6 months after NPPV (6-mo PaCO2). Results 6-mo PaCO2 seemed to be most related to continuation of NPPV (p=0.019). Patients with 6-mo PaCO2 of less than 60 mmHg had maintained a significantly lower PaCO2 value 6 to 24 months after NPPV (p=0.04) and had a significantly higher continuation rate of NPPV (p=0.03) than those with a 6-mo PaCO2 of 60 mmHg or more. Annual hospitalization rates due to respiratory deterioration were not associated with the 6-mo PaCO2 level, but fatal hospitalization rates during the first year of NPPV were significantly correlated with relatively high 6-mo PaCO2 (p=0.008). Conclusion A relatively low 6-mo PaCO2 value was predictive of long-term use of NPPV. The target values of 6-mo PaCO2 may, therefore, be less than 60 mmHg in COPD patients with extremely severe hypercapnia, although more prospective studies are needed.
著者
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Oga Toru
Department Of Pharmacology Kyoto University Faculty Of Medicine
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Chin Kazuo
Department Of Physical Therapeutics Kyoto University
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Sumi Kensuke
Department Of Respiratory Medicine National Hospital Organization Minami-kyoto Hospital
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Mishima Michiaki
Department Of Respiratory Medicine Graduate School Of Medicine Kyoto University
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Kurasawa Takuya
Department Of Electrical And Electronic Engineering Shizuoka University
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Machida Kazuko
Department Of Internal Medicine Nagoya City University Medical School
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Sato Atsuo
Department Of Cell Differentiation Institute Of Molecular Embryology And Genetics Kumamoto Universit
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Tsuboi Tomomasa
Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Japan
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Tsuboi Tomomasa
Department of Rehabilitation Medicine, Kyoto University Hospital
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Oguri Susumu
Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan
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Ohi Motoharu
Sleep Medical Center, Osaka Kaisei Hospital, Japan
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Sato Atsuo
Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan
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Chin Kazuo
Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Japan
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Machida Kazuko
Department of Respiratory Medicine, National Tokyo Hospital, Japan
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Kurasawa Takuya
Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Japan
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