What are the benefits of noninvasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

While prospective randomized trials have involved relatively small numbers of patients (<1000 total), a consistent treatment benefit has been demonstrated, and noninvasive ventilation has been recommended as first-line therapy in the management in COPD patients with hypercapnic respiratory failure. Systematic reviews and meta-analyses have all come to the same conclusion. Noninvasive ventilation reduces the need for intubation, mortality, complications, and length of stay in patients with COPD.

However, the magnitude of the benefit of noninvasive ventilation differs given some inconsistencies in the included studies. The largest review concluded that noninvasive ventilation decreased the intubation rate by 28% (95% confidence interval [CI], 15-40%), in-hospital mortality rate by 10% (95% CI, 5-15%), and absolute reduction in length of stay by 4.57 days (95% CI, 2.30-6.38 d). [13] The benefit was most pronounced in patients with more severe COPD exacerbations, defined by an initial pH of less than 7.30. The magnitude of effect was even more pronounced in this group, with intubation rates decreased by 34% (95% CI, 22-46%), mortality reduction of 12% (95% CI, 6-18%), and absolute reduction in the length of stay by 5.59 days (95% CI, 3.66-7.52 d). Investigations with less severely affected patients did not demonstrate any benefit in any of these outcomes.

In another review, greater improvement in respiratory acidosis, hypercapnia, and tachypnea was noted after 1 hour on noninvasive ventilation, along with fewer complications related to intubation. [14]


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