Noninvasive ventilation for Acute COPD Exacerbations

Incomplete

Brochard L, et al. "Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease". New England Journal of Medicine. 1995. 333(13):817-822.
PubMed • Full text

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Clinical Question

In patients with acute exacerbations of chronic obstructive pulmonary disease, does noninvasive ventilation decrease the need for endotracheal intubation?

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

Outcomes

Comparisons are intensive therapy vs. standard therapy.