Comparison between the initiation of long-term NIV after an acute episode or at steady state: a French SPLF-ANTADIR cohort analysis
2 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
3 CHU Rouen
4 Fédération ANTADIR
5 HPMetz UNEOS - Hôpitaux Privés de Metz - Hôpital Robert Schuman -UNEOS
6 CHU Pitié-Salpêtrière [AP-HP]
7 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
8 CSGA - Centre des Sciences du Goût et de l'Alimentation [Dijon]
9 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
10 CHU de Bordeaux Pellegrin [Bordeaux]
11 CHU Angers - Centre Hospitalier Universitaire d'Angers
12 LMA - Laboratoire Mécanismes d'Accidents
13 Clinique Médicale et Pédagogique Edouard Rist
14 Clinique Saint-Laurent
15 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
16 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
17 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
18 CH Le Havre
19 Hôpital Raymond Poincaré [AP-HP]
20 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
21 Centre Hospitalier Libourne
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Résumé
Long term non-invasive ventilation (LT-NIV) is widely used for chronic respiratory failure in conditions such as chronic obstructive pulmonary disease (COPD), neuromuscular disorders, and obesity hypoventilation syndrome (OHS). Aim: Compare indications, clinical outcomes, and settings for LT-NIV initiated following an acute exacerbation vs. at steady state. Methods: Prospective national observational multicenter study including adult patients suffering for respiratory failure needing LT-NIV. Patients were classified based on timing of NIV initiation (after acute exacerbation (AE) vs. stable condition (SC)). Results: Among 3494 patients, 43% started LT-NIV following acute exacerbation: 27.4% had COPD (66,5% introduced following AE), 26% had amyotrophic lateral sclerosis (ALS) (20.4% introduced following AE), 21.5% had OHS (50.9% introduced following AE), and 5.8 % had muscular dystrophies (18.6% introduced following AE). The body mass index (BMI) was higher in acute (30.1 ± 11.5 kg/m2) compared to the stable group (28.6 ± 10.9 kg/m2) (p<0.001). FEV1 was lower in the acute group and blood gas measurements showed a higher PaCO2 (p<0,001) in this group. Acute NIV initiation was significantly associated: in COPD patients with lower BMI, FEV1, and higher settings for expiratory positive pressure (EPAP), pressure support (PS) and respiratory rate (RR); in ALS with higher settings for EPAP, PS, and RR; in OHS with older age, higher BMI, lower FVC and higher settings for PS and RR. Conclusion: Initiation of LT-NIV following an acute respiratory failure is common, particularly in COPD and OHS, with settings higher compared to those initiated in stable condition.