Noninvasive ventilation for acute respiratory failure in COPD: Where do we stand?

Several randomised controlled trials have shown that non-invasive positive pressure ventilation (NIPPV) improves gas exchange, decreases the need for endotracheal intubation (ETI), reduces length of hospital stay, and decreases mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Recent studies have shown that NIPPV can also be effective in COPD exacerbations with severe respiratory failure. In these patients, NIPPV was shown to be comparable to mechanical ventilation in terms of survival, with, importantly, fewer complications. A favourable approach seems to be to start the NIPPV shortly after the patient's arrival in the hospital, as success rates increased when NIPPV was initiated early in the course of the exacerbation. NIPPV is traditionally being implemented on the intensive care unit. In experienced centres more severely ill patients can also be treated effectively on general wards with experienced staff. However, because failure rates are higher in this group with severe respiratory failure, good monitoring facilities and rapid access to ETI are obligatory. Although most studies used bilevel pressure support ventilation (BiPAP), in addition, pressure- and volume-controlled ventilation can be effective in COPD exacerbations. The choice of the interface used is largely individual with great emphasis on patient comfort.