The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Patrick B Murphy - One of the best experts on this subject based on the ideXlab platform.

  • copd Home Oxygen Therapy and Home mechanical ventilation improving admission free survival in persistent hypercapnic copd
    Chest, 2018
    Co-Authors: Gerard J Criner, Michael Dreher, Nicholas Hart, Patrick B Murphy
    Abstract:

    As seen in this CME online activity (available at http://journal.cme.chestnet.org/copd-hot-hmv), acute exacerbations of COPD are associated with significant levels of morbidity and mortality. Acute noninvasive ventilation has been demonstrated its clinical efficacy and cost-effectiveness in reducing intubation rate and mortality and in patients with acute decompensated hypercapnic exacerbations of COPD. However, those patients with evidence of chronic hypercapnic respiratory failure have worse long-term outcomes compared with patients who have only transient hypercapnia during the acute phase returning to eucapnia in the recovery stage. Indeed, there are limited options available to improve the clinical outcome in these COPD patients with persistent hypercapnia. The Home Oxygen Therapy-Home Mechanical Ventilation (HOT-HMV) trial investigated admission-free survival in patients with persistent hypercapnia following a life-threatening exacerbation requiring acute noninvasive ventilation. Phenotyping patients to ensure chronic hypercapnia enriched the trial population to identify those patients at highest risk of readmission or death following an exacerbation. The addition of Home noninvasive ventilation to Home Oxygen Therapy in patients with persistent hypercapnia led to improved admission-free survival. The noninvasive ventilation was titrated to overnight measures of transcutaneous CO2 to achieve control of nocturnal hypoventilation, which improved daytime chronic respiratory failure. Home noninvasive ventilation is a complex intervention requiring a multidisciplinary team and long-term patient follow-up to maximize the clinical benefit to the patient.

  • s37 Home mechanical ventilation hmv and Home Oxygen Therapy hot following an acute exacerbation of copd in patients with persistent hypercapnia results of the per protocol analysis from the hot hmv uk trial
    Thorax, 2017
    Co-Authors: Patrick B Murphy, Gill Arbane, R Phillips, Nicholas Hart
    Abstract:

    Introduction Intention-to-treat analysis from the HOT-HMV UK trial showed an improvement in admission-free survival with the addition of Home mechanical ventilation (HMV) to Home Oxygen Therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of COPD [JAMA;317:2177]. Delivery of HMV is essential and a per-protocol analysis was conducted to assess if patients who were adherent had better outcome. Method Patients were randomised to HOT or HOT-HMV if they had persistent hypercapnia (PaCO2 >7 kPa) 2 weeks following resolution of respiratory acidosis (pH >7.30) secondary to an acute exacerbation of COPD. NIV was titrated to nocturnal hypoventilation and patients were followed up for 1 year. Patients allocated to the HOT arm that breached safety criteria had HMV added to HOT. Patients were included in the analysis in the HOT-HMV group if they had mean adherence of >4 hours/night. Patients allocated to HOT were included up until trial withdrawal or treatment switching. Results 57 patients were randomised to HOT-HMV of whom 15 were non-adherent and 11 had missing usage data and were treated as non-adherent. 59 patients were allocated to HOT of whom 5 patients were excluded due to treatment switching. Median time to readmission or death was 1.1 months in the HOT group and 3.7 months in the HOT-HMV group (adjusted hazard ratio (HR) 0.41, 95% CI 0.23, 0.74, p= Conclusion Patients with persistent hypercapnia following an acute exacerbation of COPD who were adherent to HOT-HMV had a reduced risk of readmission or death and in addition, unlike the intention to treat analysis, had an improvement in gas exchange and a reduction in all-cause mortality at 12 months. Addition of HMV to HOT should be considered for patients with persistent hypercapnia following a life-threatening exacerbation of COPD.

  • s38 Home mechanical ventilation hmv and Home Oxygen Therapy hot following an acute exacerbation of copd in patients with persistent hypercapnia predicting 1 year admission free survival in the hot hmv uk trial
    Thorax, 2017
    Co-Authors: Patrick B Murphy, Gill Arbane, Alessandra Bisquera, Nicholas Hart
    Abstract:

    Introduction Data from the HOT-HMV UK trial showed an improvement in admission-free survival with the addition of Home mechanical non-invasive ventilation (HMV) to Home Oxygen Therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of COPD [JAMA;317:2177]. A post-hoc analysis was conducted to investigate (1) which baseline patient characteristics predict 12 month outcome and (2) the difference of these characteristics between treatment groups. Method Patients were randomised to HOT or HOT-HMV if they had persistent hypercapnia (PaCO2 >7 kPa) 2 weeks following resolution of respiratory acidosis (pH >7.30) secondary to an acute exacerbation of COPD. Non-invasive ventilation was titrated to treat nocturnal hypoventilation and patients were followed up for 1 years after discharge. Between group comparison of readmission and death were assessed in terms of baseline demographics, anthropometrics, lung function, gas exchange, quality of life and dyspnoea level. Results 116 patients were enrolled and randomised to HOT (n=59) or HOT-HMV (n=57) with (mean ±sd or median [IQR]) age 67±10 years, BMI 22 [18–26] kg/m2, FEV10.6±0.2 L, PaCO259±7 mmHg, SRI-SS 46±15, SGRQ-SS 74 [63–80], MRC dyspnoea score 5 [4–5]. Patients allocated HOT were less likely to be admitted with increasing BMI (25±5 vs 22±6 kg/m2; p=0.044). Patients allocated to HOT-HMV are were less likely to be admitted if they had higher FEV1 (0.66±0.24 vs 0.54±0.20 L; p=0.042), lower levels of dyspnoea (MRC dyspnoea score 4±1.0 vs 5±0.5; p=0.002) or higher levels of specific measures of quality of life (SGRQ-AC 85±13 vs 92±7; p=0.015) (Table 1). Baseline severity of respiratory failure did not predict 12 month outcome in either group. Conclusion Factors influencing outcome in patients with COPD and persistent hypercapnia receiving HOT-HMV treatment were airways obstruction and level of dyspnoea. However, in the patients receiving HOT alone, BMI was the only factor. There was no between group difference in with the exception of a sub-scale of the SGRQ. Interestingly, the severity of respiratory failure at baseline does not influence risk of readmission or death within 12 months as the patients all demonstrated severe chronic respiratory failure

  • hot hmv uk trial secondary outcome analysis early readmission is reduced by the addition of Home mechanical ventilation to Home Oxygen Therapy in copd patients with chronic respiratory failure following a life threatening exacerbation
    Thorax, 2016
    Co-Authors: Patrick B Murphy, Gill Arbane, Stephen Bourke, P M A Calverley, A Crooks, Lee Dowson, Nicholas Duffy, G J Gibson, Philippa Hughes, John R Hurst
    Abstract:

    Introduction Hospital readmission following treatment for a life-threatening exacerbation of COPD with acute NIV is frequent and associated with an adverse impact in terms of lung function and health related quality of life. They have been identified as a priority area in the NHS with financial penalties for any patient readmitted within 28 days following discharge. Method A multicentre open labelled randomised controlled trial recruited patients with persistent hypercapnia (PaCO 2 > 7 kPa) 2–4 weeks following resolution of acute acidosis. Patients were randomised to either Home Oxygen Therapy (HOT) or HOT and Home mechanical ventilation (HOT-HMV). HMV was titrated overnight to control nocturnal hypercapnia. Follow up was for 12 months. The primary outcome, 12-month admission free survival, has been reported previously demonstrating a significant treatment effect (ERS 2016). Secondary outcome analysis included 28-day all-cause hospital readmission and 12 month exacerbation rate. Results 116 patients were randomised (HOT = 59, HOT-HMV = 57), age 67 ± 10 years, FEV1 0.6 ± 0.2 L, PaCO 2 7.9 ± 0.9 kPa. 28-day readmission was 22 (37%) in the HOT and 7 (12%) in the HOT-HMV arm (unadjusted HR 0.27, 0.12 to 0.63, p = 0.003; adjusted HR 0.26, 0.11 to 0.61, p = 0.002) (Figure 1). 12 month exacerbation rate was reduced from median 5 (1 to 9) per year in the HOT arm to 4 (2to 6) in the HOT-HMV arm (unadjusted HR 0.64 (0.44 to 0.94); p = 0.022; adjusted HR 0.66, 0.46 to 0.95, p = 0.026). Conclusion The addition of HMV to HOT in patients with persistent hypercapnia following an acute life-threatening exacerbation of COPD reduces both 28-day readmission and 12 month exacerbation frequency. These data strongly support a change in clinical practice in the management of patients with severe COPD and persistent hypercapnia.

  • late breaking abstract improving admission free survival with Home mechanical ventilation hmv and Home Oxygen Therapy hot following life threatening copd exacerbations hot hmv uk trial nct00990132
    European Respiratory Journal, 2016
    Co-Authors: Patrick B Murphy, Gill Arbane, P M A Calverley, Lee Dowson, S C Bourke, Nick Duffy, John G Gibson, Phil Hughes, John R Hurst
    Abstract:

    Introduction: Hospital readmission and mortality following severe exacerbations of COPD requiring acute non-invasive ventilation (NIV) remain high. We hypothesised that HMV and HOT, following cessation of acute NIV, would be superior to HOT alone. Method: An open labelled parallel randomised controlled trial comparing HMV and HOT with HOT alone was performed. The primary outcome was 1-year admission free survival. Patients with persistent hypercapnia (PaCO 2 >7kPa) 2-4 weeks after resolution of respiratory acidosis were recruited. Minimisation was based on BMI, previous use of LTOT, exacerbation frequency and recruiting centre. Patients with BMI >35 kg/m 2 or OSA syndrome were excluded. Results: 116 patients were recruited (67.0±9.6 years, 53% female, BMI 21.6 (18.2-26.1)kg/m 2 , FEV 1 0.6±0.2L and PaCO 2 (7.9±0.9kPa). 59 patients were allocated to HOT (1.0 (0.5-2)Lpm) and 57 to HOT-HMV (O 2 1.0 (0.5-1.5)Lpm) with an IPAP 24 (22-26)cmH 2 O, EPAP 4 (4-5)cmH 2 O and back up rate 14 (14-16)bpm. Median admission free survival was 4.3 months in the HOT-HMV group and 1.4 months in the HOT group; unadjusted HR 0.54 (0.34-0.84); p=0.007, adjusted HR 0.49 (0.31-0.77); p=0.002. Conclusion: Although prognosis is poor in patients with persistent hypercapnia post exacerbation of COPD, the addition of HMV to HOT improved admission free survival.

Nicholas Hart - One of the best experts on this subject based on the ideXlab platform.

  • copd Home Oxygen Therapy and Home mechanical ventilation improving admission free survival in persistent hypercapnic copd
    Chest, 2018
    Co-Authors: Gerard J Criner, Michael Dreher, Nicholas Hart, Patrick B Murphy
    Abstract:

    As seen in this CME online activity (available at http://journal.cme.chestnet.org/copd-hot-hmv), acute exacerbations of COPD are associated with significant levels of morbidity and mortality. Acute noninvasive ventilation has been demonstrated its clinical efficacy and cost-effectiveness in reducing intubation rate and mortality and in patients with acute decompensated hypercapnic exacerbations of COPD. However, those patients with evidence of chronic hypercapnic respiratory failure have worse long-term outcomes compared with patients who have only transient hypercapnia during the acute phase returning to eucapnia in the recovery stage. Indeed, there are limited options available to improve the clinical outcome in these COPD patients with persistent hypercapnia. The Home Oxygen Therapy-Home Mechanical Ventilation (HOT-HMV) trial investigated admission-free survival in patients with persistent hypercapnia following a life-threatening exacerbation requiring acute noninvasive ventilation. Phenotyping patients to ensure chronic hypercapnia enriched the trial population to identify those patients at highest risk of readmission or death following an exacerbation. The addition of Home noninvasive ventilation to Home Oxygen Therapy in patients with persistent hypercapnia led to improved admission-free survival. The noninvasive ventilation was titrated to overnight measures of transcutaneous CO2 to achieve control of nocturnal hypoventilation, which improved daytime chronic respiratory failure. Home noninvasive ventilation is a complex intervention requiring a multidisciplinary team and long-term patient follow-up to maximize the clinical benefit to the patient.

  • s37 Home mechanical ventilation hmv and Home Oxygen Therapy hot following an acute exacerbation of copd in patients with persistent hypercapnia results of the per protocol analysis from the hot hmv uk trial
    Thorax, 2017
    Co-Authors: Patrick B Murphy, Gill Arbane, R Phillips, Nicholas Hart
    Abstract:

    Introduction Intention-to-treat analysis from the HOT-HMV UK trial showed an improvement in admission-free survival with the addition of Home mechanical ventilation (HMV) to Home Oxygen Therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of COPD [JAMA;317:2177]. Delivery of HMV is essential and a per-protocol analysis was conducted to assess if patients who were adherent had better outcome. Method Patients were randomised to HOT or HOT-HMV if they had persistent hypercapnia (PaCO2 >7 kPa) 2 weeks following resolution of respiratory acidosis (pH >7.30) secondary to an acute exacerbation of COPD. NIV was titrated to nocturnal hypoventilation and patients were followed up for 1 year. Patients allocated to the HOT arm that breached safety criteria had HMV added to HOT. Patients were included in the analysis in the HOT-HMV group if they had mean adherence of >4 hours/night. Patients allocated to HOT were included up until trial withdrawal or treatment switching. Results 57 patients were randomised to HOT-HMV of whom 15 were non-adherent and 11 had missing usage data and were treated as non-adherent. 59 patients were allocated to HOT of whom 5 patients were excluded due to treatment switching. Median time to readmission or death was 1.1 months in the HOT group and 3.7 months in the HOT-HMV group (adjusted hazard ratio (HR) 0.41, 95% CI 0.23, 0.74, p= Conclusion Patients with persistent hypercapnia following an acute exacerbation of COPD who were adherent to HOT-HMV had a reduced risk of readmission or death and in addition, unlike the intention to treat analysis, had an improvement in gas exchange and a reduction in all-cause mortality at 12 months. Addition of HMV to HOT should be considered for patients with persistent hypercapnia following a life-threatening exacerbation of COPD.

  • s38 Home mechanical ventilation hmv and Home Oxygen Therapy hot following an acute exacerbation of copd in patients with persistent hypercapnia predicting 1 year admission free survival in the hot hmv uk trial
    Thorax, 2017
    Co-Authors: Patrick B Murphy, Gill Arbane, Alessandra Bisquera, Nicholas Hart
    Abstract:

    Introduction Data from the HOT-HMV UK trial showed an improvement in admission-free survival with the addition of Home mechanical non-invasive ventilation (HMV) to Home Oxygen Therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of COPD [JAMA;317:2177]. A post-hoc analysis was conducted to investigate (1) which baseline patient characteristics predict 12 month outcome and (2) the difference of these characteristics between treatment groups. Method Patients were randomised to HOT or HOT-HMV if they had persistent hypercapnia (PaCO2 >7 kPa) 2 weeks following resolution of respiratory acidosis (pH >7.30) secondary to an acute exacerbation of COPD. Non-invasive ventilation was titrated to treat nocturnal hypoventilation and patients were followed up for 1 years after discharge. Between group comparison of readmission and death were assessed in terms of baseline demographics, anthropometrics, lung function, gas exchange, quality of life and dyspnoea level. Results 116 patients were enrolled and randomised to HOT (n=59) or HOT-HMV (n=57) with (mean ±sd or median [IQR]) age 67±10 years, BMI 22 [18–26] kg/m2, FEV10.6±0.2 L, PaCO259±7 mmHg, SRI-SS 46±15, SGRQ-SS 74 [63–80], MRC dyspnoea score 5 [4–5]. Patients allocated HOT were less likely to be admitted with increasing BMI (25±5 vs 22±6 kg/m2; p=0.044). Patients allocated to HOT-HMV are were less likely to be admitted if they had higher FEV1 (0.66±0.24 vs 0.54±0.20 L; p=0.042), lower levels of dyspnoea (MRC dyspnoea score 4±1.0 vs 5±0.5; p=0.002) or higher levels of specific measures of quality of life (SGRQ-AC 85±13 vs 92±7; p=0.015) (Table 1). Baseline severity of respiratory failure did not predict 12 month outcome in either group. Conclusion Factors influencing outcome in patients with COPD and persistent hypercapnia receiving HOT-HMV treatment were airways obstruction and level of dyspnoea. However, in the patients receiving HOT alone, BMI was the only factor. There was no between group difference in with the exception of a sub-scale of the SGRQ. Interestingly, the severity of respiratory failure at baseline does not influence risk of readmission or death within 12 months as the patients all demonstrated severe chronic respiratory failure

Gill Arbane - One of the best experts on this subject based on the ideXlab platform.

  • s37 Home mechanical ventilation hmv and Home Oxygen Therapy hot following an acute exacerbation of copd in patients with persistent hypercapnia results of the per protocol analysis from the hot hmv uk trial
    Thorax, 2017
    Co-Authors: Patrick B Murphy, Gill Arbane, R Phillips, Nicholas Hart
    Abstract:

    Introduction Intention-to-treat analysis from the HOT-HMV UK trial showed an improvement in admission-free survival with the addition of Home mechanical ventilation (HMV) to Home Oxygen Therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of COPD [JAMA;317:2177]. Delivery of HMV is essential and a per-protocol analysis was conducted to assess if patients who were adherent had better outcome. Method Patients were randomised to HOT or HOT-HMV if they had persistent hypercapnia (PaCO2 >7 kPa) 2 weeks following resolution of respiratory acidosis (pH >7.30) secondary to an acute exacerbation of COPD. NIV was titrated to nocturnal hypoventilation and patients were followed up for 1 year. Patients allocated to the HOT arm that breached safety criteria had HMV added to HOT. Patients were included in the analysis in the HOT-HMV group if they had mean adherence of >4 hours/night. Patients allocated to HOT were included up until trial withdrawal or treatment switching. Results 57 patients were randomised to HOT-HMV of whom 15 were non-adherent and 11 had missing usage data and were treated as non-adherent. 59 patients were allocated to HOT of whom 5 patients were excluded due to treatment switching. Median time to readmission or death was 1.1 months in the HOT group and 3.7 months in the HOT-HMV group (adjusted hazard ratio (HR) 0.41, 95% CI 0.23, 0.74, p= Conclusion Patients with persistent hypercapnia following an acute exacerbation of COPD who were adherent to HOT-HMV had a reduced risk of readmission or death and in addition, unlike the intention to treat analysis, had an improvement in gas exchange and a reduction in all-cause mortality at 12 months. Addition of HMV to HOT should be considered for patients with persistent hypercapnia following a life-threatening exacerbation of COPD.

  • s38 Home mechanical ventilation hmv and Home Oxygen Therapy hot following an acute exacerbation of copd in patients with persistent hypercapnia predicting 1 year admission free survival in the hot hmv uk trial
    Thorax, 2017
    Co-Authors: Patrick B Murphy, Gill Arbane, Alessandra Bisquera, Nicholas Hart
    Abstract:

    Introduction Data from the HOT-HMV UK trial showed an improvement in admission-free survival with the addition of Home mechanical non-invasive ventilation (HMV) to Home Oxygen Therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of COPD [JAMA;317:2177]. A post-hoc analysis was conducted to investigate (1) which baseline patient characteristics predict 12 month outcome and (2) the difference of these characteristics between treatment groups. Method Patients were randomised to HOT or HOT-HMV if they had persistent hypercapnia (PaCO2 >7 kPa) 2 weeks following resolution of respiratory acidosis (pH >7.30) secondary to an acute exacerbation of COPD. Non-invasive ventilation was titrated to treat nocturnal hypoventilation and patients were followed up for 1 years after discharge. Between group comparison of readmission and death were assessed in terms of baseline demographics, anthropometrics, lung function, gas exchange, quality of life and dyspnoea level. Results 116 patients were enrolled and randomised to HOT (n=59) or HOT-HMV (n=57) with (mean ±sd or median [IQR]) age 67±10 years, BMI 22 [18–26] kg/m2, FEV10.6±0.2 L, PaCO259±7 mmHg, SRI-SS 46±15, SGRQ-SS 74 [63–80], MRC dyspnoea score 5 [4–5]. Patients allocated HOT were less likely to be admitted with increasing BMI (25±5 vs 22±6 kg/m2; p=0.044). Patients allocated to HOT-HMV are were less likely to be admitted if they had higher FEV1 (0.66±0.24 vs 0.54±0.20 L; p=0.042), lower levels of dyspnoea (MRC dyspnoea score 4±1.0 vs 5±0.5; p=0.002) or higher levels of specific measures of quality of life (SGRQ-AC 85±13 vs 92±7; p=0.015) (Table 1). Baseline severity of respiratory failure did not predict 12 month outcome in either group. Conclusion Factors influencing outcome in patients with COPD and persistent hypercapnia receiving HOT-HMV treatment were airways obstruction and level of dyspnoea. However, in the patients receiving HOT alone, BMI was the only factor. There was no between group difference in with the exception of a sub-scale of the SGRQ. Interestingly, the severity of respiratory failure at baseline does not influence risk of readmission or death within 12 months as the patients all demonstrated severe chronic respiratory failure

  • hot hmv uk trial secondary outcome analysis early readmission is reduced by the addition of Home mechanical ventilation to Home Oxygen Therapy in copd patients with chronic respiratory failure following a life threatening exacerbation
    Thorax, 2016
    Co-Authors: Patrick B Murphy, Gill Arbane, Stephen Bourke, P M A Calverley, A Crooks, Lee Dowson, Nicholas Duffy, G J Gibson, Philippa Hughes, John R Hurst
    Abstract:

    Introduction Hospital readmission following treatment for a life-threatening exacerbation of COPD with acute NIV is frequent and associated with an adverse impact in terms of lung function and health related quality of life. They have been identified as a priority area in the NHS with financial penalties for any patient readmitted within 28 days following discharge. Method A multicentre open labelled randomised controlled trial recruited patients with persistent hypercapnia (PaCO 2 > 7 kPa) 2–4 weeks following resolution of acute acidosis. Patients were randomised to either Home Oxygen Therapy (HOT) or HOT and Home mechanical ventilation (HOT-HMV). HMV was titrated overnight to control nocturnal hypercapnia. Follow up was for 12 months. The primary outcome, 12-month admission free survival, has been reported previously demonstrating a significant treatment effect (ERS 2016). Secondary outcome analysis included 28-day all-cause hospital readmission and 12 month exacerbation rate. Results 116 patients were randomised (HOT = 59, HOT-HMV = 57), age 67 ± 10 years, FEV1 0.6 ± 0.2 L, PaCO 2 7.9 ± 0.9 kPa. 28-day readmission was 22 (37%) in the HOT and 7 (12%) in the HOT-HMV arm (unadjusted HR 0.27, 0.12 to 0.63, p = 0.003; adjusted HR 0.26, 0.11 to 0.61, p = 0.002) (Figure 1). 12 month exacerbation rate was reduced from median 5 (1 to 9) per year in the HOT arm to 4 (2to 6) in the HOT-HMV arm (unadjusted HR 0.64 (0.44 to 0.94); p = 0.022; adjusted HR 0.66, 0.46 to 0.95, p = 0.026). Conclusion The addition of HMV to HOT in patients with persistent hypercapnia following an acute life-threatening exacerbation of COPD reduces both 28-day readmission and 12 month exacerbation frequency. These data strongly support a change in clinical practice in the management of patients with severe COPD and persistent hypercapnia.

  • late breaking abstract improving admission free survival with Home mechanical ventilation hmv and Home Oxygen Therapy hot following life threatening copd exacerbations hot hmv uk trial nct00990132
    European Respiratory Journal, 2016
    Co-Authors: Patrick B Murphy, Gill Arbane, P M A Calverley, Lee Dowson, S C Bourke, Nick Duffy, John G Gibson, Phil Hughes, John R Hurst
    Abstract:

    Introduction: Hospital readmission and mortality following severe exacerbations of COPD requiring acute non-invasive ventilation (NIV) remain high. We hypothesised that HMV and HOT, following cessation of acute NIV, would be superior to HOT alone. Method: An open labelled parallel randomised controlled trial comparing HMV and HOT with HOT alone was performed. The primary outcome was 1-year admission free survival. Patients with persistent hypercapnia (PaCO 2 >7kPa) 2-4 weeks after resolution of respiratory acidosis were recruited. Minimisation was based on BMI, previous use of LTOT, exacerbation frequency and recruiting centre. Patients with BMI >35 kg/m 2 or OSA syndrome were excluded. Results: 116 patients were recruited (67.0±9.6 years, 53% female, BMI 21.6 (18.2-26.1)kg/m 2 , FEV 1 0.6±0.2L and PaCO 2 (7.9±0.9kPa). 59 patients were allocated to HOT (1.0 (0.5-2)Lpm) and 57 to HOT-HMV (O 2 1.0 (0.5-1.5)Lpm) with an IPAP 24 (22-26)cmH 2 O, EPAP 4 (4-5)cmH 2 O and back up rate 14 (14-16)bpm. Median admission free survival was 4.3 months in the HOT-HMV group and 1.4 months in the HOT group; unadjusted HR 0.54 (0.34-0.84); p=0.007, adjusted HR 0.49 (0.31-0.77); p=0.002. Conclusion: Although prognosis is poor in patients with persistent hypercapnia post exacerbation of COPD, the addition of HMV to HOT improved admission free survival.

John R Hurst - One of the best experts on this subject based on the ideXlab platform.

  • hot hmv uk trial secondary outcome analysis early readmission is reduced by the addition of Home mechanical ventilation to Home Oxygen Therapy in copd patients with chronic respiratory failure following a life threatening exacerbation
    Thorax, 2016
    Co-Authors: Patrick B Murphy, Gill Arbane, Stephen Bourke, P M A Calverley, A Crooks, Lee Dowson, Nicholas Duffy, G J Gibson, Philippa Hughes, John R Hurst
    Abstract:

    Introduction Hospital readmission following treatment for a life-threatening exacerbation of COPD with acute NIV is frequent and associated with an adverse impact in terms of lung function and health related quality of life. They have been identified as a priority area in the NHS with financial penalties for any patient readmitted within 28 days following discharge. Method A multicentre open labelled randomised controlled trial recruited patients with persistent hypercapnia (PaCO 2 > 7 kPa) 2–4 weeks following resolution of acute acidosis. Patients were randomised to either Home Oxygen Therapy (HOT) or HOT and Home mechanical ventilation (HOT-HMV). HMV was titrated overnight to control nocturnal hypercapnia. Follow up was for 12 months. The primary outcome, 12-month admission free survival, has been reported previously demonstrating a significant treatment effect (ERS 2016). Secondary outcome analysis included 28-day all-cause hospital readmission and 12 month exacerbation rate. Results 116 patients were randomised (HOT = 59, HOT-HMV = 57), age 67 ± 10 years, FEV1 0.6 ± 0.2 L, PaCO 2 7.9 ± 0.9 kPa. 28-day readmission was 22 (37%) in the HOT and 7 (12%) in the HOT-HMV arm (unadjusted HR 0.27, 0.12 to 0.63, p = 0.003; adjusted HR 0.26, 0.11 to 0.61, p = 0.002) (Figure 1). 12 month exacerbation rate was reduced from median 5 (1 to 9) per year in the HOT arm to 4 (2to 6) in the HOT-HMV arm (unadjusted HR 0.64 (0.44 to 0.94); p = 0.022; adjusted HR 0.66, 0.46 to 0.95, p = 0.026). Conclusion The addition of HMV to HOT in patients with persistent hypercapnia following an acute life-threatening exacerbation of COPD reduces both 28-day readmission and 12 month exacerbation frequency. These data strongly support a change in clinical practice in the management of patients with severe COPD and persistent hypercapnia.

  • late breaking abstract improving admission free survival with Home mechanical ventilation hmv and Home Oxygen Therapy hot following life threatening copd exacerbations hot hmv uk trial nct00990132
    European Respiratory Journal, 2016
    Co-Authors: Patrick B Murphy, Gill Arbane, P M A Calverley, Lee Dowson, S C Bourke, Nick Duffy, John G Gibson, Phil Hughes, John R Hurst
    Abstract:

    Introduction: Hospital readmission and mortality following severe exacerbations of COPD requiring acute non-invasive ventilation (NIV) remain high. We hypothesised that HMV and HOT, following cessation of acute NIV, would be superior to HOT alone. Method: An open labelled parallel randomised controlled trial comparing HMV and HOT with HOT alone was performed. The primary outcome was 1-year admission free survival. Patients with persistent hypercapnia (PaCO 2 >7kPa) 2-4 weeks after resolution of respiratory acidosis were recruited. Minimisation was based on BMI, previous use of LTOT, exacerbation frequency and recruiting centre. Patients with BMI >35 kg/m 2 or OSA syndrome were excluded. Results: 116 patients were recruited (67.0±9.6 years, 53% female, BMI 21.6 (18.2-26.1)kg/m 2 , FEV 1 0.6±0.2L and PaCO 2 (7.9±0.9kPa). 59 patients were allocated to HOT (1.0 (0.5-2)Lpm) and 57 to HOT-HMV (O 2 1.0 (0.5-1.5)Lpm) with an IPAP 24 (22-26)cmH 2 O, EPAP 4 (4-5)cmH 2 O and back up rate 14 (14-16)bpm. Median admission free survival was 4.3 months in the HOT-HMV group and 1.4 months in the HOT group; unadjusted HR 0.54 (0.34-0.84); p=0.007, adjusted HR 0.49 (0.31-0.77); p=0.002. Conclusion: Although prognosis is poor in patients with persistent hypercapnia post exacerbation of COPD, the addition of HMV to HOT improved admission free survival.

Chris Garvey - One of the best experts on this subject based on the ideXlab platform.

  • Home Oxygen Therapy for adults with chronic lung disease an official american thoracic society clinical practice guideline
    American Journal of Respiratory and Critical Care Medicine, 2020
    Co-Authors: Susan S Jacobs, Magnus Ekstrom, Jerry A Krishnan, David J Lederer, Marya Ghazipura, Tanzib Hossain, Ai Yui M Tan, Brian W Carlin, Bradley M Drummond, Chris Garvey
    Abstract:

    Background: Evidence-based guidelines are needed for effective delivery of Home Oxygen Therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations.Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1) strong recommendations for long-term Oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2) a conditional recommendation against long-term Oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3) conditional recommendations for ambulatory Oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4) a conditional recommendation for ambulatory liquid-Oxygen use in patients who are mobile outside the Home and require >3 L/min of continuous-flow Oxygen during exertion (very-low-quality evidence), and 5) a recommendation that patients and their caregivers receive education on Oxygen equipment and safety (best-practice statement).Conclusions: These guidelines provide the basis for evidence-based use of Home Oxygen Therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.

  • optimizing Home Oxygen Therapy an official american thoracic society workshop report
    Annals of the American Thoracic Society, 2018
    Co-Authors: Susan S Jacobs, David J Lederer, Chris Garvey, Carme Hernandez, Kathleen O Lindell, Sally Mclaughlin, Ann M Schneidman, Richard Casaburi, Valerie Chang, Greg P Cosgrove
    Abstract:

    More than 1.5 million adults in the United States use supplemental Oxygen for a variety of respiratory disorders to improve their quality of life and prolong survival. This document describes recommendations from a multidisciplinary workshop convened at the ATS International Conference in 2017 with the goal of optimizing Home Oxygen Therapy for adults. Ideal supplemental Oxygen Therapy is patient-specific, provided by a qualified clinician, includes an individualized prescription and therapeutic education program, and offers Oxygen systems that are safe, promote mobility, and treat hypoxemia. Recently, patients and clinicians report a growing number of problems with Home Oxygen in the United States. Oxygen users experience significant functional, mechanical, and financial problems and a lack of education related to their Oxygen equipment-problems that impact their quality of life. Health care providers report a lack of readily accessible resources needed to prescribe Oxygen systems correctly and efficiently. Patients with certain lung diseases are affected more than others because of physically unmanageable or inadequate portable systems. Analysis is needed to quantify the unintended impact that the Centers for Medicare and Medicaid Services Competitive Bidding Program has had on patients receiving supplemental Oxygen from durable medical equipment providers. Studies using effectiveness and implementation research designs are needed to develop and evaluate new models for patient education, identify effective ways for stakeholders to interface, determine the economic benefit of having respiratory therapists perform in-Home education and follow-up testing, and collaborate with technology companies to improve portable Oxygen devices. Generation of additional evidence of the benefit of supplemental Oxygen across the spectrum of advanced lung diseases and the development of clinical practice guidelines should both be prioritized.