Noninvasive ventilation for Acute COPD Exacerbations

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Brochard L, et al. "Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease". New England Journal of Medicine. 1995. 333(13):817-822.
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Clinical Question

In patients with acute exacerbations of chronic obstructive pulmonary disease, does noninvasive ventilation decrease the need for endotracheal intubation?

Bottom Line

Major Points

Guidelines

Design

  • Multicenter, prospective, randomized trial
  • N=85
    • Standard treatment (n=42)
    • Noninvasive ventilation (n=43)

Population

Inclusion Criteria

  • Diagnosis of COPD or high probability of COPD based on clinical history, physical exam, chest imaging
  • Respiratory acidosis with elevated bicarbonate level
  • Exacerbation of dyspnea lasting less than two weeks and at least two of the following:
    • Respiratory rate above 30 breaths per minute
    • Partial pressure of arterial oxygen below 45 mm Hg
    • Arterial pH below 7.35

Exclusion Criteria

  • Respiratory rate less than 12 breaths per minute
  • Immediate need for intubation (respiratory arrest, respiratory pauses with loss of consciousness or gasping, psychomotor agitation, hemodynamic instability)
  • Tracheotomy or intubation prior to admission
  • Administration of sedative medications in the 12 hours prior
  • CNS disorder unrelated to hypercapnic encephalopathy or hypoxemia
  • Cardiac arrest in the last 5 days
  • Cardiogenic pulmonary edema
  • Chronic respiratory failure resulting from other conditions (kyphoscoliosis, neuromuscular disorder, upper airway obstruction, asthma)
  • Patients who refused intubation

Baseline Characteristics

  • Mean age: years


Interventions

Outcomes

Comparisons are intensive therapy vs. standard therapy.

Primary Outcomes

Secondary Outcomes

Subgroup Analysis

Adverse Events

Criticisms

Funding

Further Reading