Noninvasive positive pressure in acute exacerbations of chronic obstructive pulmonary disease

Abstract

Purpose of reviewNoninvasive positive pressure ventilation (NIV) is standard of care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We review the most current evidence and highlight areas of uncertainty and ongoing research. We highlight key concepts for the clinician caring for patients with AECOPD which require NIV.Recent findingsImplementation of NIV in AECOPD is not uniform in spite of the evidence and guidelines. Initiation of NIV should be done early and following protocols. Low-intensity NIV remains the standard of care, although research and guidelines are evaluating higher intensity NIV. Scores to predict NIV failure continue to be refined to allow early identification and interventions. Several areas of uncertainty remain, among them are interventions to improve tolerance, length of support and titration and nutritional support during NIV.SummaryThe use of NIV in AECOPD is the standard of care as it has demonstrated benefits in several patient-centered outcomes. Current developments and research is related to the implementation and adjustment of NIV.

Guía de práctica clínica sobre el diagnóstico, manejo y seguimiento de la enfermedad pulmonar obstructiva crónica en Colombia 2023

“…Así mismo se asoció con una reducción de la duración de la estancia hospitalaria, reducción de la incidencia de complicaciones no asociada a la VNI y mejora del pH arterial, la presión arterial de oxígeno (PaCo2) sin un impacto positivo significativo en la presión arterial de dióxido de carbono (PaCO2). Aquellos pacientes con EPOC, hipercapnia estables (ambulatorios) o posterior a 15 días de egreso hospitalario tras sufrir una exacerbación que persistan con PaCo2 >52 mmhg y un pH superior a 7.35, se podrían beneficiar de ventilación no invasiva crónica diaria orientada a reducir en gran medida la hipercapnia, dado el impacto significativo en mortalidad (312)(313)(314).…”