Non-invasive ventilation for COPD exacerbations in daily clinical practice

Abstract

<b>Introduction:</b> Non-invasive ventilation (NIV) is an evidence-based treatment for patients developing acute respiratory failure due to an exacerbation of COPD. However, earlier studies from the UK show that NIV, although indicated, is often not started in clinical practice (Kaul et al. Journal of COPD 2009; Roberts et al. Thorax 2011). The aim of this study was to describe the adherence to guidelines concerning NIV initiation in the Netherlands. <b>Methods &amp; Results:</b> We retrospectively included COPD patients who were admitted with an exacerbation between December 2018 and January 2022. To date, 1123 admissions consisting of 642 unique patients (mean age 70 years, FEV1 44 ± 17 %pred.) were included. Based on the arterial blood gas, 198 cases (18%) met the inclusion criteria for NIV (pH &lt; 7.35, pCO2 &gt; 6 kPa) at admission while 71 cases (6%) met the criteria during hospitalization. In respectively 151 (76%) and 46 (65%) of these cases, NIV was started. Most common reasons noted for not starting NIV were no perceived signs of respiratory distress (14%) and the decision to refrain from NIV and start comfort care (17%). In 19% of the cases, the reason for not starting NIV was not registered. In patients who had an indication for NIV, the in-hospital mortality was lower in the group of patients who did get NIV treatment compared to patients who did not (15 vs. 34%,p=0.003) while no differences in patient characteristics were found. <b>Conclusion:</b> This preliminary data shows moderate compliance to guidelines regarding NIV initiation in COPD exacerbations, which may have a detrimental effect on the patient’s outcome. More research is needed to investigate why healthcare providers are reluctant to use NIV in clinical practice.