RESPIRATORY SUPPORT FOR CHRONIC HYPERCAPNIC RESPIRATORY FAILURE IN THE OUTPATIENT SETTINGS. LITERATURE REVIEW.

Abstract

Chronic respiratory failure (CRF) represents a common outcome of chronic bronchopulmonary diseases and significantly influences hospitalization rates, quality of life, and mortality. Improvement in patient prognosis depends not only on the management of the underlying disease but also on the targeted correction of CRF through various modalities of respiratory support, both during exacerbations and in remission phases. The principal strategies for respiratory support include oxygen therapy and non-invasive ventilation (NIV). The primary indication for long-term non-invasive ventilatory support is chronic hypercapnic respiratory failure. Prolonged use of NIV has been shown to improve pulmonary function, enhance gas exchange, increase exercise tolerance, reduce dyspnea, improve quality of life, decrease the risk of rehospitalization, and ultimately enhance survival. Currently, there is insufficient evidence regarding the initiation of non-invasive respiratory support in the outpatient setting for patients with chronic bronchopulmonary pathology. Only a limited number of studies with small cohorts have investigated home initiation of NIV in patients with hypercapnic CRF due to chronic obstructive pulmonary disease (COPD). These studies have demonstrated comparable efficacy in terms of arterial carbon dioxide levels when compared to in-hospital initiation. There is a clear need to expand research in this area by increasing sample sizes, which would allow for the development of evidence-based guidelines for outpatient NIV initiation. At present, there are no standardized recommendations regarding the timing of NIV initiation, patient selection criteria, or parameters for monitoring the effectiveness of non-invasive respiratory support in the ambulatory setting. Moreover, there is no consensus on evaluating the effectiveness of outpatient management of chronic hypercapnic respiratory failure. Thus, the development of clinical algorithms and evidence-based recommendations for the initiation, monitoring, and long-term management of patients receiving non-invasive ventilatory support in the outpatient setting remains a pressing issue.