Noninvasive ventilation for Acute COPD Exacerbations
From Wiki Journal Club
Brochard L, et al. "Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease". New England Journal of Medicine. 1995. 333(13):817-822.
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PubMed • Full text
Contents
Clinical Question
In patients with acute exacerbations of chronic obstructive pulmonary disease, does noninvasive ventilation decrease the need for endotracheal intubation?
Bottom Line
Major Points
Guidelines
Design
- Multicenter, prospective, randomized trial
- N=85
- Standard treatment (n=42)
- Noninvasive ventilation (n=43)
Population
Inclusion Criteria
- Diagnosis of COPD or high probability of COPD based on clinical history, physical exam, chest imaging
- Respiratory acidosis with elevated bicarbonate level
- Exacerbation of dyspnea lasting less than two weeks and at least two of the following:
- Respiratory rate above 30 breaths per minute
- Partial pressure of arterial oxygen below 45 mm Hg
- Arterial pH below 7.35
Exclusion Criteria
- Respiratory rate less than 12 breaths per minute
- Immediate need for intubation (respiratory arrest, respiratory pauses with loss of consciousness or gasping, psychomotor agitation, hemodynamic instability)
- Tracheotomy or intubation prior to admission
- Administration of sedative medications in the 12 hours prior
- CNS disorder unrelated to hypercapnic encephalopathy or hypoxemia
- Cardiac arrest in the last 5 days
- Cardiogenic pulmonary edema
- Chronic respiratory failure resulting from other conditions (kyphoscoliosis, neuromuscular disorder, upper airway obstruction, asthma)
- Patients who refused intubation
Baseline Characteristics
- Mean age: years
Interventions
Outcomes
Comparisons are intensive therapy vs. standard therapy.