Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Non-Invasive Ventilation for Respiratory Failure
Cochrane; ePub 2017 Jul 13; Osadnik, et al
Non-invasive ventilation (NIV) is an effective treatment strategy for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and respiratory failure, according to a recent Cochrane review. The review included 17 randomized controlled trials involving 1,264 participants (mean age 66.8 years at baseline) and compared the efficacy of NIV applied in conjunction with usual care vs usual care involving no mechanical ventilation alone in adults with acute hypercapnic respiratory failure (AHRF) due to AECOPD. Among the findings:
- NIV was more beneficial than usual care for reducing deaths and the number of patients who needed to be intubated.
- Risk of dying was reduced by 46% and risk of needing intubation was reduced by 65% with NIV.
- Patients who had NIV spent an average of 3.5 fewer days in the hospital compared to those who did not.
Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2017, Issue 7. Art. No.: CD004104. doi:10.1002/14651858.CD004104.pub4.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can lead to respiratory acidosis secondary to retention of carbon dioxide, leading to acute hypercapnic respiratory failure (AHRF). The combination of tissue acidosis, which impairs ventilatory muscle function, along with hyperinflation, which puts the expanded respiratory muscles at a mechanical disadvantage, can lead to respiratory failure and death. Traditionally, patients with AECOPD who were not responding to steroids, antibiotics, and bronchodilators would need full intubation and mechanical ventilation. Mechanical ventilation involves significant discomfort and risk, including the need for sedation, potential tissue damage during intubation, and an increased risk of pneumonia. Non-invasive ventilation (NIV) has been an important advance for these very ill patients, providing many of the advantages of mechanical ventilation without the need for intubation. —Neil Skolnik, MD