Based on meta-analysis of randomized, controlled trials, noninvasive positive pressure ventilation (NPPV) is the only intervention that improves mortality in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). However, many patients who are eligible for this intervention go untreated, and the benefits of NPPV in routine clinical practice remain incompletely defined.
Researchers evaluated data from a retrospective cohort of >25,000 patients (at 420 U.S. hospitals) who were admitted with COPD exacerbations and received either NPPV or invasive mechanical ventilation within the first 2 days of hospital admission. In propensity-matched comparisons versus invasive ventilation, NPPV was associated with significantly lower in-hospital mortality (6% vs. 9%; odds ratio, 0.64) and hospital-acquired pneumonia (2.5% vs. 3.8%), shorter length of stay (7.2 vs. 8.9 days), and lower hospital costs (mean, ≈$15,000 vs. ≈$21,000).
NPPV should be considered for any patient admitted with a severe COPD exacerbation who has respiratory acidosis (pH ≤7.35 and PaCO2>50 mmHg), severe dyspnea with signs of respiratory fatigue or increased work of breathing.