Non-invasive ventilation at home for managing COPD: ERS Guideline
Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcomes by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure.
The European Respiratory Society has release guideline to provide evidence-based recommendations for the clinical application of Long-term home non-invasive ventilation in chronic hypercapnic COPD patients.
Although the role of acute non-invasive ventilation (NIV) has been shown to improve outcomes in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.
The task force committee of European Respiratory Society delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.
PICO Question 1: Should LTH-NIV be used in stable patients with COPD (as compared to not using NIV)?
Recommendation: The ERS task force suggests LTH-NIV be used for patients with chronic stable hypercapnic COPD (conditional recommendation, low certainty evidence).
PICO Question 2: Should LTH-NIV be used after an episode of acute hypercapnic respiratory failure in patients with COPD (as compared to not using NIV)?
Recommendation: The ERS task force suggests LTH-NIV be used in patients with COPD following a life-threatening episode of acute hypercapnic respiratory failure requiring acute NIV, if hypercapnia persists following the episode (conditional recommendation, low certainty evidence).
PICO Question 3: When using LTH-NIV in COPD patients, should NIV settings be titrated to normalise or at least cause a significant reduction in PaCO2 (as compared to titrating not according to PaCO2 levels)?
Recommendation: The ERS task force suggests titrating LTH-NIV to normalise or reduce PaCO2levels in patients with COPD (conditional recommendation, very low certainty evidence).
PICO Question 4: When using LTH-NIV in COPD patients, should we use fixed pressure modes (as compared to adaptive or auto-titrating pressure modes)?
Recommendation: The ERS task force suggests using fixed pressure support mode as first-choice ventilator mode in patients with COPD using LTH-NIV (conditional recommendation, very low certainty evidence).
Journal Information: European Respiratory Journal
For more details click on the link: DOI: 10.1183/13993003.01003-2019