Home Mechanical Ventilation in Patients With Chronic Obstructive Pulmonary Disease (COPD) and Hypercapnic Response
Home Mechanical Ventilation in Patients With Chronic Obstructive Pulmonary Disease (COPD) and Hypercapnic Response
The objective of this study is to evaluate the clinical benefits of home mechanical
 ventilation associated to oxygen therapy in COPD patients with chronic respiratory failure
 (CRF) who develop hypercapnia and nocturnal respiratory acidosis secondary to oxygen
 administration.

 We will include clinically stable COPD patients with hypercapnic CRF who develop a nocturnal
 hypercapnic response to oxygen (PaCO2 increase on awakening, at night with oxygen, >10 mmHg
 respect to PaCO2 breathing room air and awake). Obstructive sleep apnoea syndrome (OSAS) will
 previously have been excluded.

 Patients will be admitted to the Pneumology ward where a nocturnal pulsioxymetry breathing
 oxygen therapy will be performed. Arterial blood gas samples will be taken at awakening
 (7AM).

 Patients who develop a hypercapnic response to oxygen will be randomised into 2 treatment
 groups:

 -  Oxygen therapy group

 -  Home mechanical ventilation plus oxygen therapy group Home mechanical ventilation will
 be performed with a bilevel pressure ventilator. Functional respiratory variables as
 well as quality of life and sleep at onset and after 6 months treatment will be
 compared.

 The principal outcome will be the evolution of arterial blood gases (PaCO2) between the two
 groups.
Inclusion Criteria:

 -  Elderly patients < 80 years old.

 -  COPD (ERS/ATS (FEV1 < 80%, FEV1/FVC < 70%, TLC > 80%)).

 -  Oxygen therapy indication (PaO2 < 55 mmHg or 55-59 associated to pulmonary arterial
 hypertension, chronic Cor Pulmonale, Chronic Heart failure, arrhythmias or
 polyglobulia).

 -  PaCO2 > 50 mm Hg.

 -  Clinically stable at least prior to one month.

 -  Hypercapnic response: increasing PaCO2 > 10 mmHg at 7 a.m after all night with oxygen
 compared with PaCO2 when awake and without oxygen therapy.

 Exclusion Criteria:

 -  Active smoker.

 -  Bronchiectasis or tuberculous after-effects.

 -  Chronic respiratory failure secondary to thorax cage or neuromuscular diseases.

 -  BMI > 35 kg/m2

 -  OSAS.

 -  Locomotor system problems that disable 6 minutes walking test execution.

 -  Patients with tracheostomy.

 -  Other serious comorbidity (i.e chronic heart failure functional class > II NYHA,
 cancer or chronic renal failure that requires dialysis.