Noninvasive positive pressure ventilation in acute COPD exacerbation

19 Jul

Cochrane review

•Reviewed 14 RCT’s involving adult patients with COPD exacerbation that compared usual medical care (UMC) alone to UMC plus NPPV

•UMC included any of the following: O2, bronchodilators, steroids, theophylline, antibiotics, diuretics, heparin

•NPPV duration varied among studies

NPPV compared to UMC alone showed:

  • decreased need for intubation,
  • improvement in pH,
  • reduced treatment failure, complications and length of hospital stay

•There was significant reduction in risk of mortality with NPPV of 48% compared to UMC

Mortality NNT of 10 (For every 10 patients treated with NPPV, avoid 1 death)

Intubation NNT of 4 (For every 4 patients treated with NPPV, avoid 1 intubation)

Bottom line: Try NPPV early in the course of respiratory failure due to COPD before severe acidosis to reduce the risk of endotracheal intubation, treatment failure and mortality

Submitted by F. DiFranco.

Reference(s): Ram FSF, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease (Review). Cochrane Library. July 2009.; picture

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