Discontinuing noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations: a randomised controlled trial

Sellarés, Jacobo; Ferrer, Miquel; Antón, Antonio; Loureiro, Hugo; Bencosme, Carolina; Alonso, Rodrigo; Martínez-Olondris, Pilar; Sayas, Javier; Peñacoba, Patricia; Torres, Antoni

doi:10.1183/13993003.01448-2016

Cited by 33 publications

(26 citation statements)

References 38 publications

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“…Discontinuation of NIV after recovery from an episode of hypercapnic ARF in COPD patients without previous domiciliary ventilation can be safely done directly, without nocturnal prolongation of NIV, if patients tolerate unassisted breathing 27 . A recent real-life retrospective observational study described the NIV weaning protocol used in 51 patients with hypercapnic ARF due to COPD exacerbation 28 .…”

Section: Barcelona Respiratory Networkmentioning

confidence: 99%

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Ferrer¹

2021

BRN

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There is strong evidence suggesting use of non-invasive ventilation in patients with severe exacerbation of chronic obstructive pulmonary disease, while use of high-flow nasal therapy in this indication is promising. However, current data suggest that non-invasive ventilation provides limited benefit in de novo acute respiratory failure, and specifically in immunocompromised patients. In this indication, high-flow nasal therapy is increasingly used, but new studies are needed to confirm its superiority over standard oxygen or non-invasive ventilation. In patients undergoing planned extubation, high-flow nasal therapy is effective in preventing re-intubation in patients at lower risk for this complication, while the combination of both non-invasive ventilation and high-flow nasal therapy appears the best strategy for those at higher risk for post-extubation respiratory failure. Finally, providing supplemental oxygen and ventilation from the start of pre-oxygenation until laryngoscopy could be the most effective approach to preventing life-threatening hypoxaemia for patients undergoing endotracheal intubation.

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Section: Barcelona Respiratory Networkmentioning

confidence: 99%

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Ferrer¹

2021

BRN

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“…A recent RCT has compared immediate withdrawal with three further days of nocturnal NIV, once the acidosis had resolved and clinical parameters have stabilized (20). The study primary end-point was relapse of hypercapnic respiratory failure within eight days of discontinuation.…”

Section: Niv In Acute Hypercapnic Respiratory Failurementioning

confidence: 99%

Update: non-invasive ventilation in chronic obstructive pulmonary disease

Shah¹,

D’Cruz²,

Murphy³

2018

J. Thorac. Dis.

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Chronic obstructive pulmonary disease (COPD) remains a common cause of morbidity and mortality worldwide. Patients with COPD and respiratory failure, whether acute or chronic have a poorer prognosis than patients without respiratory failure. Non-invasive ventilation (NIV) has been shown to be a useful tool in both the acute hospital and chronic home care setting. NIV has been well established as the gold standard therapy for acute decompensated respiratory failure complicating an acute exacerbation of COPD with reduced mortality and intubation rates compared to standard therapy. However, NIV has been increasingly used in other clinical situations such as for weaning from invasive ventilation and to palliate symptoms in patients not suitable for invasive ventilation. The equivocal evidence for the use of NIV in chronic hypercapnic respiratory failure complicating COPD has recently been challenged with data now supporting a role for therapy in selected subgroups of patients. Finally the review will discuss the emerging role of high flow humidified therapy to support or replace NIV in certain clinical situation.

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“…Unfortunately, only a limited number of studies evaluated the weaning from NIV once acidosis and respiratory distress are solved, proposing different weaning methods but not clearly establishing the superiority of one over the others [3–6]. A recently published randomized controlled trial (RCT) questioned the utility of the weaning phase [5]. In this RCT, Sellares et al compared the prolongation of NIV for three nights after recovery from an AHRF episode to direct NIV discontinuation in COPD patients without previous domiciliary ventilation [5].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Ventilation Weaning in Acute Hypercapnic Respiratory Failure due to COPD Exacerbation: A Real-Life Observational Study

Faverio

Stainer

Giacomi

et al. 2019

Canadian Respiratory Journal

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The most recent British Thoracic Society/Intensive Care Society (BTS/ICS) guidelines on the use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF) suggest to maximize NIV use in the first 24 hours and to perform a slow tapering. However, a limited number of studies evaluated the phase of NIV weaning. The aim of this study is to describe the NIV weaning protocol used in AHRF due to acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), patients’ characteristics, clinical course, and outcomes in a real-life intermediate respiratory care unit (IRCU) setting. We performed a retrospective study on adult patients hospitalized at the IRCU of San Gerardo Hospital, Monza, Italy, from January 2015 to April 2017 with a diagnosis of AHRF due to COPD exacerbation. The NIV weaning protocol used in our institution consists of the interruption of one of the three daily NIV sessions at the time, starting from the morning session and finishing with the night session. The 51 patients who started weaning were divided into three groups: 20 (39%) patients (median age 80 yrs, 65% males) who completed the protocol and were discharged home without NIV (Completed Group), 20 (39%) did not complete it because they were adapted to domiciliary ventilation (Chronic NIV Group), and 11 (22%) interrupted weaning ex abrupto mainly due to NIV intolerance (Failed Group). Completed Group patients were older, had a higher burden of comorbidities, but a lower severity of COPD compared to Chronic NIV Group. Failed Group patients experienced higher frequency of delirium after NIV discontinuation. None of the patients who completed weaning had AHRF relapse during hospitalization. While other NIV weaning methods have been previously described, our study is the first to describe a protocol that implies the interruption of a ventilation session at the time. The application of a weaning protocol may prevent AHRF relapse in the early stages of NIV interruption and in elderly frail patients.

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Discontinuing noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations: a randomised controlled trial

Cited by 33 publications

References 38 publications

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Update: non-invasive ventilation in chronic obstructive pulmonary disease

Noninvasive Ventilation Weaning in Acute Hypercapnic Respiratory Failure due to COPD Exacerbation: A Real-Life Observational Study

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