The Effects of Withdrawing Long-Term Nocturnal Non-Invasive Ventilation in COPD Patients

BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

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Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients

Respirology ◽

10.1111/resp.12327 ◽

2014 ◽

Vol 19 (6) ◽

pp. 857-865 ◽

Cited By ~ 32

Author(s):

Jean-Christian Borel ◽

Jean-Louis Pepin ◽

Christophe Pison ◽

Aurélien Vesin ◽

Jesus Gonzalez-Bermejo ◽

...

Keyword(s):

Invasive Ventilation ◽

Non Invasive ◽

Copd Patients ◽

Non Invasive Ventilation

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A prospective observational study on long-term non invasive ventilation (L-T NIV) in COPD patients attending an inpatient pulmonary rehabilitation program (PRP)

10.1183/13993003.congress-2018.pa840 ◽

2018 ◽

Author(s):

Claudia Mannini ◽

Biagio Campana ◽

Paolo Innocente Banfi ◽

Eleonora Volpato ◽

Antonella Arcadu ◽

...

Keyword(s):

Observational Study ◽

Pulmonary Rehabilitation ◽

Prospective Observational Study ◽

Rehabilitation Program ◽

Invasive Ventilation ◽

Non Invasive ◽

Copd Patients ◽

Non Invasive Ventilation ◽

Pulmonary Rehabilitation Program

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Non invasive ventilation as an additional tool for exercise training

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2015.286 ◽

2015 ◽

Vol 10 ◽

Author(s):

Nicolino Ambrosino ◽

Paolo Cigni

Keyword(s):

Exercise Training ◽

Exercise Tolerance ◽

Ventilatory Support ◽

Invasive Ventilation ◽

Additional Tool ◽

Non Invasive ◽

Copd Patients ◽

Non Invasive Ventilation

Recently, there has been increasing interest in the use of non invasive ventilation (NIV) to increase exercise capacity. In individuals with COPD, NIV during exercise reduces dyspnoea and increases exercise tolerance. Different modalities of mechanical ventilation have been used non-invasively as a tool to increase exercise tolerance in COPD, heart failure and lung and thoracic restrictive diseases. Inspiratory support provides symptomatic benefit by unloading the ventilatory muscles, whereas Continuous Positive Airway Pressure (CPAP) counterbalances the intrinsic positive end-expiratory pressure in COPD patients. Severe stable COPD patients undergoing home nocturnal NIV and daytime exercise training showed some benefits. Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking. Despite these results, the role of NIV as a routine component of pulmonary rehabilitation is still to be defined.

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