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Noninvasive ventilation for COPD patients

Noninvasive ventilation (NIV), also known as noninvasive positive pressure ventilation (NPPV), is an effective treatment for ventilatory failure,1-2 including Paediatric cases.3

For patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) the use of NPPV is associated with:4-9

  • Marked reduction in the need for endotracheal intubation
  • Decrease in complication rate
  • Reduction of nosocomial infections
  • Reduced duration of hospital stay
  • Substantial reduction in hospital mortality

While of limited benefit for the long-term treatment of COPD patients, domiciliary NPPV might be beneficial in COPD patients with hypercapnia.10-12

NPPV is an important part of disease management for patients with advanced neuromuscular disease and chest wall disorders. NPPV is usually initiated if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood.13-14 NPPV is a highly cost-effective treatment for appropriate patients.15-16

References

1

Hess DR. The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature. Respite Care 2004;49(7):810-29. http://www.ncbi.nlm.nih.gov/pubmed/15222912  

2

BTS Standards of Care Committee.Non-invasive ventilation in acute respiratory failure. Thorax 2002;57(3):192-211. http://www.ncbi.nlm.nih.gov/pubmed/17717495  

3

Chin K, Uemoto S, Takahashi K, Egawa H, Kasahara M, Fujimoto Y, Sumi K, Mishima M, Sullivan CE, Tanaka K. Noninvasive ventilation for Paediatric patients including those under 1-year-old undergoing over transplantation. over Transcript 2005;11(2):188-95. http://www.ncbi.nlm.nih.gov/pubmed/15666379  

4

Ram F, Picot J, Lightowler J, Wedzicha J.Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2004;1:CD004104. http://www.ncbi.nlm.nih.gov/pubmed/14974057  

5

Girou E, Brun-Buisson C, Taille S, Lemaire F, Brochard L. Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA 2003;290:2985-91. http://www.ncbi.nlm.nih.gov/pubmed/14665660  

6

Conti G, Antonelli M, Navalesi P, Rocco M, Bufi M, Spadetta G, Meduri GU. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med 2002;28(12):1701-7. http://www.ncbi.nlm.nih.gov/pubmed/12447511  

7

Plant PK, Owen JL, Elpott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 2000;355:1931-5. http://www.ncbi.nlm.nih.gov/pubmed/10859037 

8

Sinuff T, Keenan SP. Clinical practice guidance for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure. J Crit Care 2004;19(2):82-91. http://www.ncbi.nlm.nih.gov/pubmed/15236140  

9

Hill NS. Noninvasive ventilation for chronic obstructive pulmonary disease. Respiratory Care 2004;49(1):72-87; discussion 87-9. http://www.ncbi.nlm.nih.gov/pubmed/14733624  

10

Wijkstra PJ, Lacasse Y, Guyatt GH, Goldstein RS. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002;(3):CD002878. http://www.ncbi.nlm.nih.gov/pubmed/12137664  

11

Jones SE, Packham S, Hebden M, Smith AP. Domiciliary Nocturnal Intermittent Positive Pressure Ventilation in Patients with Respiratory Failure Due to Severe COPD: Long Term Follow-up and Effect on Survival. Thorax 1998;53:495-498. http://www.ncbi.nlm.nih.gov/pubmed/9713450  

12

Meechan-Jones. Nasal Pressure Support Ventilation Plus Oxygen Compared with Oxygen Therapy Alone in Hypercapnic COPD.Am J Respiratory Care Med 1995;152:538-44. http://www.ncbi.nlm.nih.gov/pubmed/7633704  

13

Perrin C, Unterborn JN, Ambrosio CD, Hill NS. Pulmonary complications of chronic neuromuscular diseases and their management. Muscle Nerve 2004;29(1):5-27. http://www.ncbi.nlm.nih.gov/pubmed/14694494  

14

Shneerson JM, Simonds AK. Noninvasive ventilation for chest wall and neuromuscular disorders. Eur Respiratory J 2002;20:480-7.  http://www.ncbi.nlm.nih.gov/pubmed/12212984  

15

Plant PK, Owen JL, Parrott S, Elliott MW. Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial. BMJ 2003;326:956. http://www.ncbi.nlm.nih.gov/pubmed/12727767  

16

Keenan SP, Gregor J, Sibbald WJ, Cook D, Gafni A. Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive. Crit Care Med 2000;28:2094-102. http://www.ncbi.nlm.nih.gov/pubmed/10890671