Non-invasive ventilation in chronic obstructive pulmonary disease

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This guideline focuses on the use of non-invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients with acute type 2 respiratory failure. This guidance was prepared on behalf of the multidisciplinary Guideline Development Group convened by the Clinical Standards Department of the Royal College of Physicians (RCP) and the British Thoracic Society (BTS) in association with the Intensive Care Society (ICS).

Key recommendations

  • NIV should be considered within the first 60 minutes of hospital arrival in all patients with an acute exacerbation of COPD in whom a respiratory acidosis persists despite maximum standard medical treatment.
  • A clearly documented treatment plan for NIV, including how potential failure will be dealt with and whether escalation to intubation and mechanical ventilation is indicated, should be recorded in the case notes at the outset of treatment.
  • Whenever possible, the patient and carers should be involved in these discussions.
  • Once started, patient comfort, breathing synchrony and enhanced compliance are key factors in determining outcome.
  • Low starting pressures increase patient compliance, but should be quickly adjusted upwards to achieve therapeutic effect.
  • If effective, treatment will usually be required until the acute cause has resolved, commonly within about 3 days.

This guideline updates the 2002 British Thoracic Society (BTS) guideline, Non-invasive ventilation in acute respiratory failure and has been produced for clinicians caring for COPD patients in the emergency and ward areas of acute hospitals. It has been developed in accordance with the principles laid down by the Appraisal of Guidelines for Research and Evaluation (AGREE) – summarised in Appendix 1 of the guidelines.