0
CME Resource Center |

The Role of Noninvasive Ventilation in the Management and Mitigation of Exacerbations and Hospital Admissions/Readmissions for the Patient With Moderate to Severe COPD (Multimedia Activity)CME Resource Center

David P. White, MD; Gerard J. Criner, MD; Michael Dreher, MD; Nicholas Hart, MD; Fred W. Peyerl, PhD, MBA; Lisa F. Wolfe, MD; Suzette A. Chin, MD, FCCP
Author and Funding Information

From the Division of Sleep Medicine (Dr White), Sleep Disorders Research Program, Brigham and Women’s Hospital, Boston, MA; Division of Pulmonary & Critical Care Medicine (Dr Criner), Temple University School of Medicine, Philadelphia, PA; Department of Cardiology, Pneumology, Vascular Medicine, and Intensive Care Medicine (Dr Dreher), University Hospital Aachen, Aachen, Germany; Clinical and Academic Direct Lane Fox Respiratory Unit (Dr Hart), St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, England; Boston Strategic Partners (Dr Peyerl), Boston, MA; Division of Pulmonary and Critical Care Medicine (Dr Wolfe), Northwestern University, Chicago, IL; and Pulmonary & Critical Care (Dr Chin), Respiratory Consultants of Georgia, Cartersville, GA.

CORRESPONDENCE TO: David P. White, MD, 4340 E Cedar Ave, Denver, CO 80246; e-mail: dpwhite@partners.org


Editor’s Note: With this article, CHEST is offering the first in an occasional series of peer-reviewed official journal CME (and non-CME) Multimedia Activities. These activities will permit readers to view video and other interactive online material and then claim CME. To access the online CME activity, go to http://journal.cme.chestnet.org/home-nivcopd.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Release date: May 11, 2015; expiration date: May 11, 2016.


Chest. 2015;147(6):1704-1705. doi:10.1378/chest.15-0394
Text Size: A A A
Published online

As seen in this CME online activity (available at http://journal.cme.chestnet.org/home-niv-copd), COPD is a common and debilitating disease and is currently the third leading cause of death in the United States. The role of noninvasive ventilation (NIV) in the management of severe, hypercapnic COPD has been controversial. However, it was concluded that current data would support the following recommendations. Patients with COPD with a waking Paco2 > 50 to 52 mm Hg, an overnight Paco2 > 55 mm Hg, or both who are symptomatic and compliant with other therapies should be eligible for NIV. In addition, multiple previous hospital admissions for COPD exacerbation, requiring noninvasive/invasive mechanical ventilation, strongly suggest a need for chronic NIV. Patients with COPD with a BMI > 30 kg/m2 respond particularly well to this therapy. When the decision is made to start NIV, this treatment is probably best initiated during a short hospitalization, although this can be accomplished in the clinic, home, or sleep laboratory if well-trained clinicians are available. Newer modes of NIV such as volume-assured pressure support, particularly with autotitrating expiratory positive airway pressure (EPAP), may create the opportunity for home NIV initiation easier for less experienced physicians. Regardless of the mode selected, inspiratory pressures must be in the 20 to 25 cm H2O range to meaningfully increase tidal volume, reduce work of breathing, and, importantly, reduce waking arterial Paco2. EPAP is currently set at 4 to 5 cm H2O, although future technologies may allow this to be individualized to maximally reduce auto-positive end expiratory pressure. The NIV device should have a backup rate although it is controversial as to whether this should be set at a high (18-20 breaths/min) vs a low (8-10 breaths/min) rate. The proper use of NIV in appropriately chosen patients with COPD can improve quality of life and increase survival. Ongoing studies are assessing if the frequency of future hospitalizations can be reduced with NIV. Thus, NIV should be strongly considered in any patients with COPD meeting the criteria described here.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543