EBQ:NIPPV in COPD

Under Review Journal Club Article

Brochard L et al. "Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.". NEJM. 1995. 333(13):817-22.
PubMed Full text PDF

Clinical Question

Can NIPPV be used to avoid endotracheal intubation in acute COPD exacerbation?

Conclusion

NIPPV could avoid endotracheal intubation, the length of the hospital stay, and the in-hospital mortality rate in the selected patients.

Design

Multicenter prospective randomized trial at five hospitals

Population

Adult patients with known or suspected COPD (by history, exam or CXR).

Inclusion Criteria

Respiratory acidosis/elevated HCO3 with exacerbation of dyspnea lasting less than two weeks. And at least two of the following:

- a respiratory rate above 30 bpm

- PaO2 <45 mm Hg

- Arterial pH < 7.35 after 10min RA

Exclusion Criteria

- RR < 12 bmp or need for immediate intubation (as defined below)

- tracheotomy or endotracheal intubation performed before admission

- the administration of sedative drugs within the previous 12 hrs

- CNS disorder unrelated to hypercapnic encephalopathy or hypoxemia

- cardiac arrest (within previous 5 days)

- cardiogenic pulmonary edema;

- kyphoscoliosis as the cause of chronic respiratory failure or a neuromuscular disorder

- upper airway obstruction or asthma

- a clear cause of decompensation requiring specific treatment (e.g., peritonitis, septic shock, acute myocardial infarction, pulmonary thromboembolism, pneumothorax, hemoptysis, severe pneumonia, or recent surgery or trauma); a facial deformity; or enrollment in other investigative protocols.

- Refusal to undergo endotracheal intubation