Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jun;165(6):1469-1480.
doi: 10.1016/j.chest.2024.02.040. Epub 2024 Feb 28.

Applying Noninvasive Ventilation in Treatment of Acute Exacerbation of COPD Using Evidence-Based Interprofessional Clinical Practice

Mary Jo S Farmer  1 , Christine D Callahan  2 , Ashley M Hughes  3 , Karen L Riska  4 , Nicholas S Hill  5
Affiliations
Review

Applying Noninvasive Ventilation in Treatment of Acute Exacerbation of COPD Using Evidence-Based Interprofessional Clinical Practice

Mary Jo S Farmer et al. Chest. 2024 Jun.

Abstract

When administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to COPD exacerbation in conjunction with guideline-recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Identifying patients appropriate for NIV, and subsequently providing close monitoring to determine an improvement in clinical condition involves a team consisting of physician, nurse, and respiratory therapist in institutions that successfully implement NIV. We describe to our knowledge the first known evidence-based algorithm speaking to initiation, titration, monitoring, and weaning of NIV in treatment of acute exacerbation of COPD that incorporates the necessary interprofessional collaboration among physicians, nurses, and respiratory therapists caring for these patients.

Keywords: COPD; acute exacerbation of COPD; interprofessional team; noninvasive ventilation.

PubMed Disclaimer

Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: N. S. H. serves on the advisory board for Breas, Invent Medical, and Liberate Medical; is a consultant for Caire, Fisher Paykel, Inogen, and Philips Respironics; and is a speaker for Fisher Paykel. None declared (M. J. S. F., C. D. C., A. M. H., K. L. R.).

Figures

Figure 1
Figure 1
A-D, Interprofessional team application of noninvasive ventilation for acute exacerbation of COPD. ABG = arterial blood gas; EPAP = expiratory positive airway pressure; IPAP = inspiratory positive airway pressure; NIV = noninvasive ventilation; PEEP = positive end-expiratory pressure; RR = respiratory rate; RT = respiratory therapist; Spo2, oxygen saturation.
Figure 1
Figure 1
A-D, Interprofessional team application of noninvasive ventilation for acute exacerbation of COPD. ABG = arterial blood gas; EPAP = expiratory positive airway pressure; IPAP = inspiratory positive airway pressure; NIV = noninvasive ventilation; PEEP = positive end-expiratory pressure; RR = respiratory rate; RT = respiratory therapist; Spo2, oxygen saturation.
Figure 1
Figure 1
A-D, Interprofessional team application of noninvasive ventilation for acute exacerbation of COPD. ABG = arterial blood gas; EPAP = expiratory positive airway pressure; IPAP = inspiratory positive airway pressure; NIV = noninvasive ventilation; PEEP = positive end-expiratory pressure; RR = respiratory rate; RT = respiratory therapist; Spo2, oxygen saturation.
Figure 1
Figure 1
A-D, Interprofessional team application of noninvasive ventilation for acute exacerbation of COPD. ABG = arterial blood gas; EPAP = expiratory positive airway pressure; IPAP = inspiratory positive airway pressure; NIV = noninvasive ventilation; PEEP = positive end-expiratory pressure; RR = respiratory rate; RT = respiratory therapist; Spo2, oxygen saturation.
Figure 2
Figure 2
Noninvasive ventilation asynchrony. Arrows highlight the asynchronous events. Paw = airway pressure; EAdi = electrical activity of the diaphragm. Reprinted from Longhini et al. doi:10.3389/fmed.2022.1119924.
See this image and copyright information in PMC

References

    1. Brochard L., Mancebo J., Wysocki M., et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333(13):817–822. - PubMed
    1. Osadnik C.R., Tee V.S., Carson-Chahhoud K.V., Picot J., Wedzicha J.A., Smith B.J. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;7(7):CD004104. - PMC - PubMed
    1. Plant P.K., Owen J.L., Elliott M.W. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomized controlled trial. Lancet. 2000;355(9219):1931–1935. - PubMed
    1. Rochwerg B., Brochard L., Elliott M.W., et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2) - PubMed
    1. Plant P.K., Owen J.L., Elliott M.W. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax. 2001;56(9):708–712. - PMC - PubMed

Publication types

MeSH terms