Comparison between the initiation of long-term NIV after an acute episode or at steady state: a French SPLF-ANTADIR cohort analysis

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). <bold>Aim:</bold> Compare indications, clinical outcomes, and settings for LT-NIV initiated following an acute exacerbation vs. at steady state. <bold>Methods:</bold> 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)). <bold>Results:</bold> 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/m<sup>2</sup>) compared to the stable group (28.6 ± 10.9 kg/m<sup>2</sup>) (<italic>p</italic><0.001). FEV1 was lower in the acute group and blood gas measurements showed a higher PaCO<sub>2</sub> (<italic>p</italic><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. <bold>Conclusion:</bold> 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.

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Published
2025-09-27
DOI
https://doi.org/10.1183/13993003.congress-2025.pa2062
Primary Topic
Respiratory Support and Mechanisms
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article
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article

Comparison between the initiation of long-term NIV after an acute episode or at steady state: a French SPLF-ANTADIR cohort analysis

L. Grassion, Laure Goubert, Arnaud Prigent, S. Pontier et al.
Respiratory Support and Mechanisms
article

Comparison between the initiation of long-term NIV after an acute episode or at steady state: a French SPLF-ANTADIR cohort analysis

L. Grassion, Laure Goubert, Arnaud Prigent, S. Pontier, A Perel, Franck Lavergne, Claudio A. Rabec, A. Mallart, Jésus Gonzalez‐Bermejo, Bruno Ribeiro-Baptista, K. Sedkaoui, Christophe Perrin, Marjolaine Georges, Maxime Patout, A. Cuvelier, C. Morelot, Jacqueline Delrieu, Romain Kessler, B. Melloni, Frédéric Gagnadoux, Fréderic Claudé, S. Jaffré, Magalie Mercy, Jean-François Muir, Claudia Llontop, Pierre Cervantes, Hélène Prigent, Anne Guillemot
article en

Abstract

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). <bold>Aim:</bold> Compare indications, clinical outcomes, and settings for LT-NIV initiated following an acute exacerbation vs. at steady state. <bold>Methods:</bold> 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)). <bold>Results:</bold> 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/m<sup>2</sup>) compared to the stable group (28.6 ± 10.9 kg/m<sup>2</sup>) (<italic>p</italic><0.001). FEV1 was lower in the acute group and blood gas measurements showed a higher PaCO<sub>2</sub> (<italic>p</italic><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. <bold>Conclusion:</bold> 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.

Université Le Havre Normandie (FR), International University of Monaco (MC), Université de Bordeaux (FR), BioClinica (United States) (US), Université de Lille (FR), Sorbonne Université (FR), Centre Hospitalier Universitaire de Besançon (FR), Toulouse Mathematics Institute (FR), Fédération Antadir (FR), IRT M2P (FR), Centre d’Investigation Clinique Innovation Technologique de Nancy (FR), Saint Laurent Polyclinique (FR), Pitié-Salpêtrière Hospital (FR), Groupe Hospitalier du Havre (FR), Centre d'Investigation Clinique de Nantes (FR), Hôpital Raymond-Poincaré (FR), Observatoire des Sciences de l’Univers Terre Homme Environnement Temps Astronomie (FR), Maison des Sciences sociales et des Humanités de Dijon (FR), Scientific Centre of Monaco (MC), Institut de Chirurgie Guidée par l'Image (FR), Henri Poincaré Institute (FR), Université d'Angers (FR), Université de Rouen Normandie (FR)
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Respiratory Support and Mechanisms
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