Noninvasive Ventilation For Acute Respiratory Failure
Publication Date: August 1, 2017
Last Updated: December 16, 2022
Treatment
COPD Exacerbation
Bilevel NIV may be considered in COPD patients with an acute exacerbation in three clinical settings:
- To prevent acute respiratory acidosis — i.e., when the arterial CO2 tension (PaCO2) is normal or elevated but pH is normal.
- To prevent endotracheal intubation and invasive mechanical ventilation in patients with mild to moderate acidosis and respiratory distress, with the aim of preventing deterioration to a point when invasive ventilation would be considered.
- As an alternative to invasive ventilation in patients with severe acidosis and more severe respiratory distress.
We suggest NIV NOT be used in patients with hypercapnia who are not acidotic in the setting of a COPD exacerbation. (C, L)
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We recommend bilevel NIV for patients with acute respiratory failure (ARF) leading to acute or acute-on-chronic respiratory acidosis (pH ≤7.35) due to chronic obstructive pulmonary disease (COPD) exacerbation. (S, H)
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We recommend a trial of bilevel NIV in patients considered to require endotracheal intubation and mechanical ventilation, unless the patient is immediately deteriorating. (S, M)
- Bilevel NIV2 should be considered when the pH is ≤7.35, PaCO is >45 mmHg and the respiratory rate is >20–24 breaths/min despite standard medical therapy.
- Bilevel NIV remains the preferred choice for patients with COPD who develop acute respiratory acidosis during hospital admission. There is no lower limit of pH below which a trial of NIV is inappropriate. However, the lower the pH, the greater risk of failure, and patients must be very closely monitored with rapid access to endotracheal intubation and invasive ventilation if not improving.
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Overview
Title
Noninvasive Ventilation For Acute Respiratory Failure
Authoring Organizations
American Thoracic Society
European Respiratory Society