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Title: The Effect of Hospital Discharge with Empiric Noninvasive Ventilation on Mortality in Hospitalized Patients with Obesity Hypoventilation Syndrome: An Individual Patient Data Meta-Analysis.
Austin Authors: Mokhlesi, Babak;Masa, Juan Fernando;Afshar, Majid;Almadana Pacheco, Virginia;Berlowitz, David J ;Borel, Jean-Christian;Budweiser, Stephan;Carrillo, Andres;Castro-Añón, Olalla;Ferrer, Miquel;Gagnadoux, Frédéric;Golpe, Rafael;Hart, Nicholas;Howard, Mark E ;Murphy, Patrick B;Palm, Andreas;Perez de Llano, Luis A;Piper, Amanda J;Pépin, Jean Louis;Priou, Pascaline;Sánchez-Gómez, Jesús F;Soghier, Israa;Tamae Kakazu, Maximiliano;Wilson, Kevin C
Affiliation: The University of Chicago, Section of Pulmonary and Critical Care, Chicago, Illinois, United States
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
San Pedro de Alcántara Hospital, Pulmonology, Cáceres, Spain
RoMed Clinical Center Rosenheim, Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, Rosenheim, Germany
Donaustauf Hospital, Center for Pneumology, Donaustauf, Germany
American Thoracic Society, 44197, Documents Department, New York, New York, United States
Boston University, Medicine, Boston, Massachusetts, United States
Respiratory, Allergy and Sleep Research, Department of Medical Sciences, Uppsala, Sweden
Centre for Research and Development, Gavle, Sweden
Guy's & St Thomas' NHS Foundation Trust, Lane Fox Clinical Respiratory Physiology Research Centre, London, United Kingdom of Great Britain and Northern Ireland
Guy's & St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit, London, United Kingdom of Great Britain and Northern Ireland
Cellex laboratory, CibeRes ((Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028)- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
Hospital Clínic, Respiratory Intensive Care Unit Pneumology Department, Barcelona, Spain..
The University of Melbourne, Physiotherapy, Melbourne, Victoria, Australia
Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Royal Prince Alfred Hospital, Respiratory and Sleep Medicine, Camperdown, New South Wales, Australia
Loyola University Chicago, Pulmonarya and Critical Care, Maywood, Illinois, United States
Hospital Universitario Virgen Macarena, 16582, Clinical Unit of Pneumology, Sevilla, Andalucía, Spain
AGIR à dom, Research and Development, Meylan , France
Hospital JM Morales Meseguer, Intensive Care Unit, Murcia, Spain
University Hospital Lucus Augusti, 309716, Pneumology Service, Lugo, Galicia, Spain
CHU, Pneumologie, Angers, France
Complexo Hospitalario Xeral-Calde, Sección de Neumología, Lugo, Lugo, Spain
St Thomas' Hospital, Lane Fox Respiratory Unit, London, United Kingdom of Great Britain and Northern Ireland
Hospital Universitario Lucus Augusti, 309716, Lugo, Galicia, Spain
Centre Hospitalier Universitaire de Grenoble, 36724, Grenoble, France
CHU, Angers, France
Virgen de la Macarena Hospital, Sevilla, Spain
Albert Einstein College of Medicine, Bronx, New York, United States
Spectrum Health, 3591, Grand Rapids, Michigan, United States
Issue Date: May-2020 2020-02-05
Publication information: Annals of the American Thoracic Society 2020; 17(5): 627-637
Abstract: Hospitalized patients with acute-on-chronic hypercapnic respiratory failure due to obesity hypoventilation syndrome (OHS) have increased short-term mortality. It is unknown whether prescribing empiric positive airway pressure (PAP) at the time of hospital discharge reduces mortality compared to waiting for an outpatient evaluation (i.e. outpatient sleep study and outpatient PAP titration). An international, multi-disciplinary panel of experts developed clinical practice guidelines on OHS for the American Thoracic Society. The guideline panel asked whether hospitalized adult patients with acute-on-chronic hypercapnic respiratory failure suspected of having OHS, in whom the diagnosis has not yet been made, should be discharged from the hospital with or without empiric PAP treatment until the diagnosis of OHS is either confirmed or ruled out. A systematic review with individual patient data meta-analyses was performed to inform the guideline panel's recommendation. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to summarize evidence and appraise quality. The literature search identified 2,994 articles. There were no randomized trials. Ten studies met a priori study selection criteria, including two non-randomized comparative studies and eight non-randomized non-comparative studies. Individual patient data on hospitalized patients who survived to hospital discharge was obtained from nine of the studies and included a total of 1,162 patients (1,043 discharged with PAP and 119 discharged without PAP). Empiric non-invasive ventilation (NIV) was prescribed in 91.5% of patients discharged on PAP and the remainder received empiric continuous PAP (CPAP). Discharge with PAP reduced mortality at 3-months (RR 0.12, 95% CI 0.05-0.30, RD -14.5%). Certainty in the estimated effects was very low. Hospital discharge with PAP reduces mortality following acute-on-chronic hypercapnic respiratory failure in patients with OHS or suspected of having OHS. Well-designed clinical trials are needed to confirm this finding.
DOI: 10.1513/AnnalsATS.201912-887OC
ORCID: 0000-0001-8135-5433
PubMed URL: 32023419
Type: Journal Article
Appears in Collections:Journal articles

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