Pneumologie 2009; 63(9): 484-491
DOI: 10.1055/s-0029-1214993
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Prognosefaktoren bei Patienten mit COPD mit chronisch-hyperkapnischer respiratorischer Insuffizienz und außerklinischer Beatmungstherapie

Mögliche Implikationen für die tägliche PraxisPrognostic Factors for COPD Patients with Chronic Hypercapnic Respiratory Failure and Home VentilationPossible Implications for Daily RoutineS.  Budweiser1 , R.  A.  Jörres2 , F.  Heinemann1 , M.  Pfeifer1 , 3
  • 1Zentrum für Pneumologie, Klinik Donaustauf, Kooperierende Lehr- und Forschungseinrichtung der Universität Regensburg
  • 2Institut und Poliklinik für Arbeits-, Umwelt- und Sozialmedizin, Ludwig-Maximilians-Universität München
  • 3Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg
Further Information

Publication History

eingereicht 2. 7. 2009

akzeptiert nach Revision 16. 7. 2009

Publication Date:
11 September 2009 (online)

Zusammenfassung

Die Prävalenz der Patienten mit schwerer COPD und chronisch hyperkapnischer respiratorischer Insuffizienz (CHRI), die einer außerklinischen Beatmung zugeführt werden, hat erheblich zugenommen. Im Hinblick auf die Schwere der Erkrankung erscheint eine multidimensionale Betrachtung sinnvoll. Der Basenüberschuss (BE) reflektiert die langfristige metabolische Kompensation der chronischen Hyperkapnie und stellt einen vielversprechenden, leicht fassbaren und integrativen Parameter der CHRI dar. Dieser konnte zusätzlich zu Ernährungsstatus und Lungenüberblähung als unabhängiger Prädiktor des Langzeitüberlebens detektiert werden. Darüber hinaus sind in Zusammenschau mit der Literatur sowohl zur Krankheitseinschätzung als zur Verlaufsbeurteilung weitere Marker sowie häufige Komorbiditäten zu berücksichtigen. Dementsprechend sollte auch die Entscheidung für eine außerklinische Beatmung nicht nur auf der Basis von Symptomen bzw. der chronischen Hyperkapnie erfolgen, sondern auch Faktoren einbeziehen, welche die Schwere der Erkrankung in spezifischer Weise abbilden. Retrospektive Daten deuten zudem daraufhin, dass auch COPD-Patienten mit wiederholten hyperkapnischen Dekompensationen oder nach prolongierter Beatmungsentwöhnung für eine außerklinische Beatmung infrage kommen. Dies ist allerdings noch in prospektiven Studien weiter zu evaluieren.

Abstract

The prevalence of patients with severe COPD and chronic hypercapnic respiratory failure (CHRF) receiving non-invasive home ventilation has greatly increased. With regard to disease severity, a multidimensional assessment seems indicated. Base excess (BE), in particular, reflects the long-term metabolic response to chronic hypercapnia and thus constitutes a promising, easily accessible, integrative marker of CHRF. Infact, BE as well as nutritional status and lung hyperinflation have been identified as independent predictors of long-term survival. In addition and in a review with the literature, a broad panel of indices including frequent comorbidities are helpful for assessment and monitoring purposes of patients with CHRF. Accordingly, in view of the patients' individual risk profile, the decision about the initiation of NIV should probably not rely solely on symptoms and chronic persistent hypercapnia but include a spectrum of factors that specifically reflect disease severity. Owing to the physiologically positive effects of NIV and according to retrospective data, patients with COPD and recurrent hypercapnic respiratory decompensation and patients with prolonged mechanical ventilation and/or difficult weaning could also be considered for long-term non-invasive ventilation. This, however, has to be corroborated in future prospective trials.

Literatur

  • 1 Mannino D M, Buist A S. Global burden of COPD: risk factors, prevalence, and future trends.  Lancet. 2007;  370 765-773
  • 2 Budweiser S, Jorres R A, Pfeifer M. Treatment of respiratory failure in COPD.  Int J Chron Obstruct Pulmon Dis. 2008;  3 605-618
  • 3 Magnussen H, Kirsten A M, Kohler D. et al . Leitlinien zur Langzeit-Sauerstofftherapie. Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. [Guidelines for long-term oxygen therapy. German Society for Pneumology and Respiratory Medicine].  Pneumologie. 2008;  62 748-756
  • 4 Budweiser S, Jorres R A, Pfeifer M. Noninvasive home ventilation for chronic obstructive pulmonary disease: indications, utility and outcome.  Curr Opin Pulm Med. 2008;  14 128-134
  • 5 Lloyd-Owen S J, Donaldson G C, Ambrosino N. et al . Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey.  Eur Respir J. 2005;  25 1025-1031
  • 6 Budweiser S, Jorres R A, Riedl T. et al . Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation.  Chest. 2007;  131 1650-1658
  • 7 Nickol A H, Hart N, Hopkinson N S. et al . Mechanisms of improvement of respiratory failure in patients with COPD treated with NIV.  Int J Chron Obstruct Pulmon Dis. 2008;  3 453-462
  • 8 Windisch W, Dreher M, Storre J H. et al . Nocturnal non-invasive positive pressure ventilation: physiological effects on spontaneous breathing.  Respir Physiol Neurobiol. 2006;  150 251-260
  • 9 Windisch W, Haenel M, Storre J H. et al . High-intensity non-invasive positive pressure ventilation for stable hypercapnic COPD.  Int J Med Sci. 2009;  6 72-76
  • 10 Windisch W. Impact of home mechanical ventilation on health-related quality of life.  Eur Respir J. 2008;  32 1328-1336
  • 11 Tuggey J M, Plant P K, Elliott M W. Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis.  Thorax. 2003;  58 867-871
  • 12 Budweiser S, Hitzl A P, Jörres R A. Impact of noninvasive home ventilation on long-term survival in chronic hypercapnic respiratory failure: a prospective observational study.  Int J Clin Pract. 2007;  61 1516-1522
  • 13 Casanova C, Celli B R, Tost L. et al . Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD.  Chest. 2000;  118 1582-1590
  • 14 Clini E, Sturani C, Rossi A. et al . The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients.  Eur Respir J. 2002;  20 529-538
  • 15 McEvoy R D, Pierce R J, Hillman D. et al . Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial.  Thorax. 2009;  64 561-566
  • 16 Roussos C, Koutsoukou A. Respiratory failure.  Eur Respir J Suppl. 2003;  47 3s-14s
  • 17 Aida A, Miyamoto K, Nishimura M. et al . Prognostic value of hypercapnia in patients with chronic respiratory failure during long-term oxygen therapy.  Am J Respir Crit Care Med. 1998;  158 188-193
  • 18 Chailleux 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;  109 741-749
  • 19 Cooper C B, Waterhouse J, Howard P. Twelve year clinical study of patients with hypoxic cor pulmonale given long term domiciliary oxygen therapy.  Thorax. 1987;  42 105-110
  • 20 Nizet T A, van den Elshout F J, Heijdra Y F. et al . Survival of chronic hypercapnic COPD patients is predicted by smoking habits, comorbidity, and hypoxemia.  Chest. 2005;  127 1904-1910
  • 21 Celli B R, Cote C G, Marin J M. et al . The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 1005-1012
  • 22 Casanova C, Cote C, de Torres J P. et al . Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2005;  171 591-597
  • 23 Chailleux E, Laaban J P, 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 1460-1466
  • 24 Martinez F J, Foster G, Curtis J L. et al . Predictors of mortality in patients with emphysema and severe airflow obstruction.  Am J Respir Crit Care Med. 2006;  173 1326-1334
  • 25 Schols A M, Broekhuizen R, Weling-Scheepers C A. et al . Body composition and mortality in chronic obstructive pulmonary disease.  Am J Clin Nutr. 2005;  82 53-59
  • 26 Vestbo J, Prescott E, Almdal T. et al . Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study.  Am J Respir Crit Care Med. 2006;  173 79-83
  • 27 Chambellan A, Chailleux E, Similowski T. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy.  Chest. 2005;  128 1201-1208
  • 28 Cote C, Zilberberg M D, Mody S H. et al . Haemoglobin level and its clinical impact in a cohort of patients with COPD.  Eur Respir J. 2007;  29 923-929
  • 29 Similowski T, Agusti A, MacNee W. et al . The potential impact of anaemia of chronic disease in COPD.  Eur Respir J. 2006;  27 390-396
  • 30 Budweiser S, Heidtkamp F, Jorres R A. et al . Predictive significance of six-minute walk distance for long-term survival in chronic hypercapnic respiratory failure.  Respiration. 2008;  75 418-426
  • 31 Oga T, Nishimura K, Tsukino M. et al . Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status.  Am J Respir Crit Care Med. 2003;  167 544-549
  • 32 Watz H, Waschki B, Boehme C. et al . Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study.  Am J Respir Crit Care Med. 2008;  177 743-751
  • 33 de Torres J P, Cote C G, Lopez M V. et al . Sex differences in mortality in patients with COPD.  Eur Respir J. 2009;  33 528-535
  • 34 Mahler D A, Wells C K. Evaluating clinical methods for rating dyspnea.  Chest. 1988;  93 580-586
  • 35 Nishimura 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 1434-1440
  • 36 Budweiser S, Hitzl A P, Joerres R A. et al . Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis.  Respir Res. 2007;  8 92
  • 37 de Voogd J N, Wempe J B, Koeter G H. et al . Depressive symptoms as predictors of mortality in patients with COPD.  Chest. 2009;  135 619-625
  • 38 Ng T P, Niti M, Tan W C. et al . Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life.  Arch Intern Med. 2007;  167 60-67
  • 39 Criee C P. Empfehlungen der Deutschen Atemwegsliga zur Messung der inspiratorischen Muskelfunktion [Recommendations of the German Airway League (Deutsche Atemwegsliga) for the determination of inspiratory muscle function].  Pneumologie. 2003;  57 98-100
  • 40 Budweiser S, Jorres R A, Criee C P. et al . Prognostic value of mouth occlusion pressure in patients with chronic ventilatory failure.  Respir Med. 2007;  101 2343-2351
  • 41 Sin D D, Anthonisen N R, Soriano J B. et al . Mortality in COPD: Role of comorbidities.  Eur Respir J. 2006;  28 1245-1257
  • 42 Dahl M, Vestbo J, Lange P. et al . C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2007;  175 250-255
  • 43 Bozinovski S, Hutchinson A, Thompson M. et al . Serum amyloid a is a biomarker of acute exacerbations of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2008;  177 269-278
  • 44 Man S F, Xing L, Connett J E. et al . Circulating fibronectin to C-reactive protein ratio and mortality: a biomarker in COPD?.  Eur Respir J. 2008;  32 1451-1457
  • 45 Budweiser S, Luchner A, Jorres R A. et al . NT-proBNP in chronic hypercapnic respiratory failure: A marker of disease severity, treatment effect and prognosis.  Respir Med. 2007;  101 2003-2010
  • 46 Oswald-Mammosser M, Weitzenblum E, Quoix E. et al . Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure.  Chest. 1995;  107 1193-1198
  • 47 Kessler R, Faller M, Fourgaut G. et al . „Natural history” of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease.  Am J Respir Crit Care Med. 2001;  164 219-224
  • 48 Dierkesmann R, Gillissen A, Lorenz J. et al . Beurteilungs- und Prognosekriterien bei COPD [Assessment and outcome parameters in COPD].  Pneumologie. 2009;  63 49-55
  • 49 Jones P W. Health status and the spiral of decline.  COPD. 2009;  6 59-63
  • 50 Oga T, Nishimura K, Tsukino M. et al . Longitudinal deteriorations in patient reported outcomes in patients with COPD.  Respir Med. 2007;  101 146-153
  • 51 Prescott E, Almdal T, Mikkelsen K L. et al . Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study.  Eur Respir J. 2002;  20 539-544
  • 52 Aniwidyaningsih W, Varraso R, Cano N. et al . Impact of nutritional status on body functioning in chronic obstructive pulmonary disease and how to intervene.  Curr Opin Clin Nutr Metab Care. 2008;  11 435-442
  • 53 Schols A M, 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 1791-1797
  • 54 Windisch W, Kostic S, Dreher M. et al . Outcome of patients with stable COPD receiving controlled noninvasive positive pressure ventilation aimed at a maximal reduction of Pa(CO2).  Chest. 2005;  128 657-662
  • 55 Diaz O, Begin P, Andresen M. et al . Physiological and clinical effects of diurnal noninvasive ventilation in hypercapnic COPD.  Eur Respir J. 2005;  26 1016-1023
  • 56 Diaz O, Begin P, Torrealba B. et al . Effects of noninvasive ventilation on lung hyperinflation in stable hypercapnic COPD.  Eur Respir J. 2002;  20 1490-1498
  • 57 Budweiser S, Heinemann F, Fischer W. et al . Long-term reduction of hyperinflation in stable COPD by non-invasive nocturnal home ventilation.  Respir Med. 2005;  99 976-984
  • 58 Budweiser S, Heinemann F, Meyer K. et al . Weight gain in cachectic COPD patients receiving noninvasive positive-pressure ventilation.  Respir Care. 2006;  51 126-132
  • 59 Kohnlein T, Criee C P, Kohler D. et al . Multizentrische Studie: „Nicht-invasive Beatmung bei Patienten mit schwerer chronisch obstruktiver Bronchitis und Emphysem (COPD) [Multicenter study on „non-invasive ventilation in patients with severe chronic obstructive pulmonary disease and emphysema (COPD)”].  Pneumologie. 2004;  58 566-569
  • 60 Rabe K F, Hurd S, Anzueto . et al . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2007;  176 532-555
  • 61 Schucher B, Magnussen H. Beatmung bei chronisch ventilatorischer Insuffizienz [Mechanical ventilation in chronic ventilatory insufficiency].  Pneumologie. 2007;  61 644-652
  • 62 Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation – a consensus conference report.  Chest. 1999;  116 521-534
  • 63 Grant B JB, Saltzman A R. Respiratory functions of the lung. In: Baum GL, Wolinsky E (Hrsg) Textbook of pulmonary diseases. New York, NY; Lippincott Williams and Wilcins 1993: 202
  • 64 Chu C M, Chan V L, Lin A W. et al . Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure.  Thorax. 2004;  59 1020-1025
  • 65 Budweiser S, Hitzl A P, Jorres R A. et al . Impact of non-invasive home ventilation on long-term survival in chronic hypercapnic COPD – a prospective observational study.  Int J Clin Pract. 2007;  61 1516-1522
  • 66 Mehta S, Hill N S. Noninvasive ventilation.  Am J Respir Crit Care Med. 2001;  163 540-577
  • 67 Jones S E, Packham S, Hebden M. et al . Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long-term follow up and effect on survival.  Thorax. 1998;  53 495-498
  • 68 Ferrer M, Valencia M, Nicolas J M. et al . Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial.  Am J Respir Crit Care Med. 2006;  173 164-170
  • 69 Nava S, Ambrosino N, Clini E. et al . Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial.  Ann Intern Med. 1998;  128 721-728
  • 70 Heinemann F, Roesch F, Budweiser S. et al . Home mechanical ventilation in the post weaning period: long-term results in difficult-to-wean-patients with COPD.  Eur Resp J Suppl. 2008;  330s P1940
  • 71 Quinnell T G, Pilsworth S, Shneerson J M. et al . Prolonged invasive ventilation following acute ventilatory failure in COPD: weaning results, survival, and the role of noninvasive ventilation.  Chest. 2006;  129 133-139

PD Dr. med. Stephan Budweiser

Klinik Donaustauf, Zentrum für Pneumologie

Ludwigstraße 68
93093 Donaustauf

Email: stephan.budweiser@klinik.uni-regensburg.de