Can High-Intensity Noninvasive Positive-Pressure Ventilation Improve COPD Exacerbation Outcomes?

Compared with standard low-pressure NPPV, high-pressure NPPV resulted in the need for fewer intubations, but generalizability is constrained by study limitations.

Evidence supports using noninvasive positive-pressure ventilation (NPPV) in patients who are hospitalized with exacerbations of chronic obstructive pulmonary disease (COPD) and hypercapnic respiratory failure (NEJM JW Gen Med Sep 15 2017 and Cochrane Database Syst Rev 2017; 7:4104). However, when patients worsen or do not improve with this intervention, they usually are intubated. Investigators in China evaluated 8100 patients who were admitted with COPD exacerbations and who received 6 hours of low-intensity NPPV (maximum inspiratory positive airway pressure [IPAP], ≤20 cm H₂O); 300 patients (mean age, 73) with persistently elevated PaC0₂ levels after the initial 6 hours were randomized to change to high-intensity NPPV (IPAP titrated to 30…

Reviewing Author

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Can High-Intensity Noninvasive Positive-Pressure Ventilation Improve COPD Exacerbation Outcomes?

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Reviewing Author