Premium
High‐intensity non‐invasive ventilation in stable hypercapnic COPD: Evidence of efficacy and practical advice
Author(s) -
van der Leest Sietske,
Duiverman Marieke L.
Publication year - 2019
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13450
Subject(s) - medicine , copd , intensive care medicine , hypercapnia , normocapnia , non invasive ventilation , ventilation (architecture) , noninvasive ventilation , pulmonary disease , anesthesia , respiratory system , mechanical ventilation , veterinary medicine , engineering , mechanical engineering , forensic science
Patients with end‐stage chronic obstructive pulmonary disease (COPD) frequently develop chronic hypercapnic respiratory failure (CHRF), with disabling symptoms and poor survival. The use of long‐term nocturnal non‐invasive ventilation (NIV) to treat CHRF in COPD has long been subject of debate due to conflicting evidence. However, since the introduction of high‐intensity NIV (HI‐NIV) in COPD, physiological and clinical benefits have been shown. HI‐NIV refers to specific ventilator settings used for NIV aimed at achieving normocapnia or the lowest partial arterial carbon dioxide pressure (PaCO 2 ) values as possible. This review will provide an overview of existing evidence of the efficacy of HI‐NIV stable COPD patients with CHRF. Secondly, we will discuss hypotheses underlying NIV benefit in stable hypercapnic COPD, providing insight into better patient selection and hopefully more individually titrated HI‐NIV. Finally, we will provide practical advice on how to initiate and follow‐up patients on HI‐NIV, with special emphasis on monitoring that should be available during the initiation and follow‐up of HI‐NIV, and will discuss more extended monitoring techniques that could improve HI‐NIV treatment in the future.