Noninvasive Positive Pressure Ventilation for Exacerbation of Chronic Obstructive Pulmonary Disease

Bryan Zorko; Michael Ritchie

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Jun 1, 2020 Issue

Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Noninvasive Positive Pressure Ventilation for Exacerbation of Chronic Obstructive Pulmonary Disease

BRYAN ZORKO, MD, and MICHAEL RITCHIE, MD

Am Fam Physician. 2020 Jun 1;101(11):online.

Details for This Review

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NONINVASIVE POSITIVE PRESSURE VENTILATION FOR EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Benefits	Harms
1 in 12 had death prevented	1 in 9 had discomfort leading to discontinuation of treatment
1 in 5 avoided endotracheal intubation	1 in 3 had minor complications such as ear pain or skin damage

NONINVASIVE POSITIVE PRESSURE VENTILATION FOR EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Benefits	Harms
1 in 12 had death prevented	1 in 9 had discomfort leading to discontinuation of treatment
1 in 5 avoided endotracheal intubation	1 in 3 had minor complications such as ear pain or skin damage

Study Population: Adults with hypercapnic respiratory failure caused by exacerbation of chronic obstructive pulmonary disease (COPD)

Efficacy End Points: Death prevention; reduced endotracheal intubation; shorter duration of hospital stay

Harm End Points: Discomfort leading to discontinuation of treatment; minor complications such as ear pain and skin damage

Narrative: COPD is a progressive lung disease characterized by hyperinflation of the lungs, including emphysema and chronic bronchitis. COPD death rates in the United States have declined since 1999, predominantly in males.1 Endotracheal intubation with ventilatory support for severe exacerbations is difficult to reverse. Noninvasive positive pressure ventilation (NIPPV), if effective in avoiding endotracheal intubation, could, therefore, save lives and reduce suffering.

Of the 17 studies in the Cochrane review,1 all were randomized trials with parallel group design, comparing usual care plus NIPPV to usual care alone, with some variations in usual care. NIPPV was delivered via face mask, nasal mask, or either based on preference.1 A total of 1,264 adults with severe COPD exacerbation and hypercapnic respiratory failure (pH < 7.35; partial pressure of carbon dioxide > 45 mm Hg [6.0 kPa]) were enrolled.

NIPPV reduced both primary outcomes, including death (odds ratio [OR] = 0.4; 95% CI, 0.3 to 0.5; absolute difference = 8.4%; number needed to treat [NNT] = 12) and endotracheal i

Author disclosure: No relevant financial affiliations.

References

1. Osadnik CR, Tee VS, Carson-Chahhoud KV, et al. Noninvasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;(7):CD004104.

2. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426.

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