Identifier les facteurs associés à la survie chez les patients BPCO sous VNI au long cours avec un recul à 5 ans

Abstract : Introduction: chronic obstructive pulmonary disease (COPD) can evolve to the stage of chronic respiratory failure with alveolar hypoventilation. So far only long-term oxygen therapy has been shown to prolong life of these patients. Nocturnal non-invasive ventilation (NIV) in this indication still highly debated, although it is widely used word-wide. Objective: Analyze the survival predictive factors in COPD patients under NIV with a 5 years follow-up, using the COPD patient cohort in Aquitaine. Methods: this is an observational, retrospective and multicenter study performed on NIV-ventilated COPD patients from the PALOMB cohort. After completing a data collection of our patients with the help of health professionals and health providers; we conducted a descriptive analysis of our population and its evolution at 5 years. Then we evaluated predictive factors of survival of patients under NIV after 5 years of follow-up. Results: 83 patients were included in our cohort, 51 patients were included in the 5-year analysis with an average age of 66 years old and 65% of men. 33,7% of patients started NIV for chronic hypercapnia, 41% following a hypercapnic exacerbation and 25,3% for an overlap syndrome. The average BMI was 29.9 kg /m2. When NIV was introduced mean ± SD FEV1 was 38.3 ± 14.47% predicted, the mean ± SD PaCO2 was 53.11 ± 7.04 mmHg and PaO2 was 57.05 ± 9.78 mmHg. Ventilation was performed with an average PEEP of 5.6 cmH2O and an IPAP of 15.3 cmH2 ; compliance at 1 year was 6.82 ± 3.4h. There was a statistically significant improvement in PaCO2 over time after VNI (-6.63 mmHg at 1 year), as well as a decrease in the number of hospitalizations. FEV1 and relative distension (VR / CPT) remain stable over time under NIV. In bivariate analysis, high FEV 1 and high weight were associated with survival. In multivariate analysis, only the presence of ischemic heart disease and cardiac arr! hythmia were associated with mortality. Conclusion: this retrospective study shows that there are only few severe patients ventilated in the Palomb cohort. Five-year mortality of severe COPD was 33%. There appears to be an efficacy of NIV on PaCO2 and the number of hospitalizations. Ischemic heart disease and cardiac arrhythmia are risk factors for five-year mortality.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02089128
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Wednesday, April 3, 2019 - 2:45:00 PM
Last modification on : Thursday, May 30, 2019 - 5:58:33 PM

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Claire Bon. Identifier les facteurs associés à la survie chez les patients BPCO sous VNI au long cours avec un recul à 5 ans. Médecine humaine et pathologie. 2018. ⟨dumas-02089128⟩

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