Does NPPV for Inpatient COPD Exacerbation Require Weaning?

Although noninvasive positive-pressure ventilation (NPPV) lowers mortality, intubation rate, and hospital length of stay (LOS) in patients admitted with chronic obstructive pulmonary disease (COPD) exacerbations and acute hypercapnic respiratory failure (AHRF; NEJM JW Hosp Med Oct 2017 and Cochrane Database Syst Rev 2017; 7:4104), we know little about strategies for discontinuing NPPV. Investigators randomized 120 intermediate care unit patients who were receiving NPPV for COPD exacerbation and AHRF — when each patient was able to tolerate 4 hours of unassisted breathing — to either NPPV wean (3 days of nocturnal NPPV) or direct discontinuation to supplemental oxygen or room air.

Compared with NPPV wean, direct discontinuation of NPPV did no…