Day-to-Day Variability of Parameters Recorded by Home Noninvasive Positive Pressure Ventilation for Detection of Severe Acute Exacerbations in COPD

Weipeng Jiang; Yencheng Chao; Xiaoyue Wang; Cuicui Chen; Jian Zhou; Yuanlin Song

doi:10.2147/COPD.S299819

Day-to-Day Variability of Parameters Recorded by Home Noninvasive Positive Pressure Ventilation for Detection of Severe Acute Exacerbations in COPD

Int J Chron Obstruct Pulmon Dis. 2021 Mar 22:16:727-737. doi: 10.2147/COPD.S299819. eCollection 2021.

Authors

Weipeng Jiang^#¹, Yencheng Chao^#¹, Xiaoyue Wang¹, Cuicui Chen¹, Jian Zhou¹, Yuanlin Song^{1

2

3

4

5}

Affiliations

¹ Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
² Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Shanghai, 200032, People's Republic of China.
³ National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200000, People's Republic of China.
⁴ Department of Pulmonary Medicine, Zhongshan Hospital, Qingpu Branch, Fudan University, Shanghai, 201700, People's Republic of China.
⁵ Department of Pulmonary Medicine, Jinshan Hospital of Fudan University, Shanghai, 201508, People's Republic of China.

^# Contributed equally.

Abstract

Background: Home noninvasive positive pressure ventilation (NPPV) can be considered not only as an evidence-based treatment for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients, but also as a predictor for detecting severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods: In this retrospective observational study, we collected clinical exacerbations information and daily NPPV-related data in a cohort of COPD patients with home NPPV for 6 months. Daily changes in NPPV-related parameters' variability prior to AECOPD were examined using two-way repeated measures ANOVA and individual abnormal values (>75th or <25th percentile of individual baseline parameters) were calculated during 7-day pre-AECOPD period. Multivariate logistic regression was used to identify the independent risk factors associated with AECOPD that then were incorporated into the nomogram.

Results: Between January 1, 2018, and January 1, 2020, a total of 102 patients were included and 31 (30.4%) participants experienced hospitalization (AECOPD group) within 6 months. Respiratory rate changed significantly from baseline at 1, 2 or 3 days prior to admission (p<0.001, respectively) in the AECOPD group. The number of days with abnormal values of daily usage, leaks, or tidal volume during the 7-day pre-AECOPD period in the AECOPD group was higher than in the stable group (p<0.001, respectively). On multivariate analysis, 7-day mean respiratory rate (OR 1.756, 95% CI 1.249-2.469), abnormal values of daily use (OR 1.918, 95% CI 1.253-2.934) and tidal volume (OR 2.081, 95% CI 1.380-3.140) within 7 days were independently associated with the risk of AECOPD. Incorporating these factors, the nomogram achieved good concordance indexes of 0.962.

Conclusion: Seven-day mean respiratory rate, abnormal values of daily usage, leaks, and tidal volume within the 7-day pre-AECOPD period may be biomarkers for detection of AECOPD.

Keywords: acute exacerbations of COPD; day-to-day variability; detection; noninvasive positive pressure ventilation.

Publication types

Observational Study

MeSH terms

Hospitalization
Humans
Hypercapnia
Noninvasive Ventilation*
Positive-Pressure Respiration
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / therapy