Abstract
Non-invasive ventilation (NIV) is frequently used as a treatment for acute hypercapnic respiratory failure (AHRF) in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In the UK, many patients with AHRF secondary to AECOPD are treated with ward-based NIV, rather than being treated in critical care. NIV has been increasingly used as an alternative to invasive ventilation and as a ceiling of treatment in patients with a ‘do not intubate’ order. This narrative review describes the evidence base for ward-based NIV in the context of AECOPD and summarises current practice and clinical outcomes in the UK.
Highlights
Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition characterised by airway inflammation and partially reversible airflow obstruction [1]
This study demonstrated that the risk of mortality following hospitalisation for COPD is highest during the immediate post-discharge period, patients remain at high risk for adverse clinical outcomes for a prolonged period of time
In a retrospective analysis of COPD patients treated with ward-based Non-invasive ventilation (NIV), Yalcinsoy et al [32] found that there were no differences in the rate of intensive care unit admission, in-hospital mortality, or length of hospital stay between patients grouped according to severity of baseline acidosis (7.20 ≤ pH ≤ 7.25 vs. 7.26 ≤ pH ≤ 7.30)
Summary
Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition characterised by airway inflammation and partially reversible airflow obstruction [1]. As part of the natural course of the disease, many patients will experience an acute exacerbation of COPD (AECOPD) [4]. Used a Medicare database of COPD patients aged ≥65 years to analyse the risk of readmission or post-discharge mortality at one-year in patients who survived to hospital discharge between 2008–2014. The readmission rate at one year was 63.5%, 66.0%, and 64.1% among those receiving invasive, noninvasive, and no ventilation, respectively. This study demonstrated that the risk of mortality following hospitalisation for COPD is highest during the immediate post-discharge period, patients remain at high risk for adverse clinical outcomes for a prolonged period of time. Patients treated with mechanical ventilation experience a very high one-year mortality rate
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