When Is Noninvasive Ventilation Indicated in Patients with COPD Exacerbations?

International guidelines recommend noninvasive positive-pressure ventilation (NPPV) for patients with chronic obstructive pulmonary disease (COPD) exacerbations and acute hypercapnic respiratory failure (AHRF) based on symptoms or low serum pH (NEJM JW Hosp Med Jul 2017 and Am J Respir Crit Care Med 2017; 195:557). To evaluate this recommendation, investigators aggregated results from 17 randomized controlled trials in which NPPV was compared with no NPPV in 1264 COPD patients with exacerbations and AHRF. Both groups received other standard therapies for COPD exacerbation.

NPPV led to the following significant outcome improvements:

• In-hospital mortality: 10% with NPPV vs. 18% with no NPPV (number needed to treat [NNT], 12)

  • Subgroup with prese…