What is the efficacy of noninvasive ventilation (NIV) in the management of acute exacerbations of 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

The case for first-line use of noninvasive ventilation in the management of acute exacerbations of COPD has been further supported by review of large administrative databases. [20, 21] Noninvasive ventilation has better outcomes than invasive mechanical ventilation when used as the initial treatment in those with acute exacerbations of COPD on several levels, including length of stay, hospital-acquired pneumonia, and mortality. However, those in whom noninvasive ventilation fails and who require intubation have a worse outcome, about three times higher than those initially treated with noninvasive ventilation. However, successfully treated patients do not have the same severity of illness as those who are initially subject to intubation and mechanical ventilation, and those in whom noninvasive ventilation fails likely represent a group whose worse outcomes are further testaments to their borderline status. [22] This further emphasizes the importance of proper patient selection for noninvasive ventilation, with the best-suited patients identified from the clinical trials summarized below.


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