EBQ:NIPPV in COPD - Revision history

Danbot: Added Criticisms and Funding sections

2026-03-21T22:43:40Z

Added Criticisms and Funding sections

← Older revision		Revision as of 22:43, 21 March 2026
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	</quiz>		</quiz>

			==Criticisms==
			*The study was unblinded due to the nature of the intervention (NIPPV vs standard therapy)
			*Conducted at a single center, limiting generalizability to other clinical settings
			*Relatively small sample size (N=85) may have limited ability to detect smaller treatment effects
			*Patients with immediate need for intubation were excluded, which may select for a less critically ill population
			*Standard medical therapy evolved after this study; current treatments may narrow the benefit of NIPPV

			==Funding==
			*Respironics Inc.
			*National Health and Medical Research Council of Australia

	==Sources==		==Sources==

Ostermayer: Text replacement - "Category:Pulm" to "Category:Pulmonary"

2016-03-22T16:12:10Z

Text replacement - "Category:Pulm" to "Category:Pulmonary"

← Older revision		Revision as of 16:12, 22 March 2016
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	<references/>		<references/>

	[[Category:EBQ]][[Category:~~Pulm~~]]		[[Category:EBQ]][[Category:Pulmonary]]

Ostermayer: /* CME */

2014-04-03T14:46:50Z

CME

← Older revision		Revision as of 14:46, 3 April 2014
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	**Since the numbers of patients requiring intubation were different in the two groups, they compared mortality rates after adjustment for endotracheal intubation, using the Mantel–Haenszel test. After adjustment, they found no significant difference, suggesting that the number of patients requiring intubation was the main factor explaining the difference in mortality		**Since the numbers of patients requiring intubation were different in the two groups, they compared mortality rates after adjustment for endotracheal intubation, using the Mantel–Haenszel test. After adjustment, they found no significant difference, suggesting that the number of patients requiring intubation was the main factor explaining the difference in mortality

	==~~CME~~==		==Review Questions==
	<quiz display=simple>		<quiz display=simple>

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	</quiz>		</quiz>


	==Sources==		==Sources==

Rossdonaldson1: /* Inclusion Criteria */

2014-02-07T23:31:01Z

Inclusion Criteria

← Older revision		Revision as of 23:31, 7 February 2014
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	===Inclusion Criteria===		===Inclusion Criteria===
	Respiratory acidosis/elevated HCO3 with exacerbation of dyspnea lasting less than two weeks.		[[Respiratory acidosis]]/elevated HCO3 with exacerbation of dyspnea lasting less than two weeks.
	And at least two of the following:		And at least two of the following:
	#a respiratory rate above 30 bpm		#a respiratory rate above 30 bpm

Rossdonaldson1: /* Guidelines */

2014-02-07T23:30:46Z

Guidelines

← Older revision		Revision as of 23:30, 7 February 2014
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	==Guidelines==		==Guidelines==
	{{quote\|NIV should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis (pH < 7.35, PaCO2 > 6 kPa [45 mm Hg]) is present. \| sign=British Thoracic Society<ref>Roberts CM, Brown JL, Reinhardt AK, et al. Non-invasive ventilation in chronic obstructive pulmonary disease:management of acute type 2 respiratory failure. Clin Med.2008;8(5):517-521</ref>}}		{{quote\|NIV should be considered in all patients with an acute exacerbation of COPD in whom a [[respiratory acidosis]] (pH < 7.35, PaCO2 > 6 kPa [45 mm Hg]) is present. \| sign=British Thoracic Society<ref>Roberts CM, Brown JL, Reinhardt AK, et al. Non-invasive ventilation in chronic obstructive pulmonary disease:management of acute type 2 respiratory failure. Clin Med.2008;8(5):517-521</ref>}}


	{{quote\|NIV improves respiratory acidosis (increases pH and decreases PaCO2) and decreases respiratory rate, severity of breathlessness, and length of hospital stay in patients with acute exacerbations of COPD. \| sign=Global Initiative for Chronic Obstructive Lung Disease (GOLD)<ref>GOLD Science Committee Methodology and summary of new recommendations. Global strategy for diagnosis, management and prevention of COPD: 2010 update. 2010</ref>}}		{{quote\|NIV improves [[respiratory acidosis]] (increases pH and decreases PaCO2) and decreases respiratory rate, severity of breathlessness, and length of hospital stay in patients with acute exacerbations of COPD. \| sign=Global Initiative for Chronic Obstructive Lung Disease (GOLD)<ref>GOLD Science Committee Methodology and summary of new recommendations. Global strategy for diagnosis, management and prevention of COPD: 2010 update. 2010</ref>}}

	{{quote\|Bi-level NIV is a beneficial support strategy that decreases the risk for invasive mechanical ventilation and possibly improves survival in selected hospitalized patients with respiratory failure \| sign=ACCP, ACP-ASIM<ref>Bach PB, Brown C, Gelfand SE, et al. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med. 2001;134(7):600-620.</ref>}}		{{quote\|Bi-level NIV is a beneficial support strategy that decreases the risk for invasive mechanical ventilation and possibly improves survival in selected hospitalized patients with respiratory failure \| sign=ACCP, ACP-ASIM<ref>Bach PB, Brown C, Gelfand SE, et al. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med. 2001;134(7):600-620.</ref>}}

Rossdonaldson1 at 23:25, 7 February 2014

2014-02-07T23:25:08Z

← Older revision		Revision as of 23:25, 7 February 2014
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	==Major Points==		==Major Points==
	*In acute COPD exacerbation, noninvasive ventilation helps avoid endotracheal intubation and complications associated with mechanical ventilation		*In acute COPD exacerbation, noninvasive ventilation helps avoid endotracheal [[intubation]] and complications associated with mechanical ventilation

	*The use of ~~noninvasive ventilation~~ significantly reduced the need for intubation as compared in the standard-treatment group (5 liters/min, nasal canula)		*The use of [[Noninvasive Ventilation]] significantly reduced the need for [[intubation]] as compared in the standard-treatment group (5 liters/min, nasal canula)

	*The frequency of complications was significantly lower in the noninvasive ventilation group.		*The frequency of complications was significantly lower in the [[noninvasive ventilation]] group.

	*Hospital stay was significantly shorter for the noninvasive ventilation group compared to the standard group.		*Hospital stay was significantly shorter for the [[noninvasive ventilation]] group compared to the standard group.

	==Guidelines==		==Guidelines==
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	==Population==		==Population==
	Adult patients with known or suspected COPD (by history, exam or CXR).		Adult patients with known or suspected [[COPD]] (by history, exam or CXR).

	===Inclusion Criteria===		===Inclusion Criteria===
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	===Exclusion Criteria===		===Exclusion Criteria===
	*RR < 12 bmp or need for immediate intubation (as defined below)		*RR < 12 bmp or need for immediate intubation (as defined below)
	*tracheotomy or endotracheal intubation performed before admission		*tracheotomy or endotracheal [[intubation]] performed before admission
	*the administration of sedative drugs within the previous 12 hrs		*the administration of sedative drugs within the previous 12 hrs
	*CNS disorder unrelated to hypercapnic encephalopathy or hypoxemia		*CNS disorder unrelated to hypercapnic encephalopathy or hypoxemia
	*cardiac arrest (within previous 5 days)		*[[cardiac arrest]] (within previous 5 days)
	*cardiogenic pulmonary edema;		*cardiogenic pulmonary edema
	*kyphoscoliosis as the cause of chronic respiratory failure or a neuromuscular disorder		*kyphoscoliosis as the cause of chronic respiratory failure or a neuromuscular disorder
	*upper airway obstruction or asthma		*upper airway obstruction or asthma
	*a clear cause of decompensation requiring specific treatment (e.g., peritonitis, septic shock, acute myocardial infarction, pulmonary thromboembolism, pneumothorax, hemoptysis, severe pneumonia, or recent surgery or trauma); a facial deformity; or enrollment in other investigative protocols.		*a clear cause of decompensation requiring specific treatment (e.g., peritonitis, [[septic shock]], [[acute myocardial infarction]], [[pulmonary thromboembolism]], [[pneumothorax]], [[hemoptysis]], severe [[pneumonia]], or recent surgery or trauma); a facial deformity; or enrollment in other investigative protocols.
	*Refusal to undergo endotracheal intubation		*Refusal to undergo endotracheal [[intubation]]

	==Interventions==		==Interventions==
	Both groups received:		Both groups received:
	*subcutaneous heparin		*[[subcutaneous heparin]]
	*antibiotics		*[[antibiotics]]
	*bronchodilators (subcutaneous terbutaline, aerosolized and intravenous albuterol, and corticosteroids or intravenous aminophylline or both)		*bronchodilators (subcutaneous terbutaline, aerosolized and intravenous albuterol, and corticosteroids or intravenous aminophylline or both)
	*electrolyte corrections.		*electrolyte corrections

	'''Standard group:'''		'''Standard group:'''
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	'''NIPPV group:'''		'''NIPPV group:'''
	*At least 6 hours daily of NIPPV by ARM 25 machine keep arterial O2Sat >90% ''(Duration of noninvasive ventilation was determined on the basis of clinical criteria and arterial-blood gas levels.)''		*At least 6 hours daily of NIPPV by ARM 25 machine keep arterial O2Sat >90% ''(Duration of [[noninvasive ventilation]] was determined on the basis of clinical criteria and arterial-blood gas levels.)''

	'''Hard criteria for intubation in either group:'''		'''Hard criteria for intubation in either group:'''
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	===Primary Outcomes===		===Primary Outcomes===
	Need for endotracheal intubation and mechanical ventilation at any point in the study:		Need for endotracheal [[intubation]] and mechanical ventilation at any point in the study:

	Thirty-one of the 42 patients (74 percent) in the standard-treatment		Thirty-one of the 42 patients (74 percent) in the standard-treatment
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	{What is one group that was excluded from the study that might benefit from NIPPV?		{What is one group that was excluded from the study that might benefit from NIPPV?
	\|type="[]"}		\|type="[]"}
	-COPD patients with 1 week of shortness of breath.		-[[COPD]] patients with 1 week of shortness of breath.
	+DNI patients with COPD exacerbation.		+DNI patients with COPD exacerbation.
	-Patients with hypoxia and hypercapnea.		-Patients with hypoxia and hypercapnea.

Rossdonaldson1: /* Conclusion */

2014-02-07T23:20:11Z

Conclusion

← Older revision		Revision as of 23:20, 7 February 2014
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	==Conclusion==		==Conclusion==
	NIPPV avoids endotracheal intubation, reduces the length of the hospital stay, and reduces the in-hospital mortality rate in selected patients.		NIPPV avoids endotracheal [[intubation]], reduces the length of the hospital stay, and reduces the in-hospital mortality rate in selected patients.

	==Major Points==		==Major Points==

Rossdonaldson1: /* Clinical Question */

2014-02-07T23:19:35Z

Clinical Question

← Older revision		Revision as of 23:19, 7 February 2014
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	==Clinical Question==		==Clinical Question==
	Can NIPPV be used to avoid endotracheal intubation in acute COPD exacerbation?		Can NIPPV be used to avoid endotracheal intubation in acute [[COPD]] exacerbation?

	==Conclusion==		==Conclusion==

Rossdonaldson1: /* Conclusion */

2014-02-07T23:17:54Z

Conclusion

← Older revision		Revision as of 23:17, 7 February 2014
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	==Conclusion==		==Conclusion==
	NIPPV ~~could avoid~~ endotracheal intubation, the length of the hospital stay, and the in-hospital mortality rate in ~~the~~ selected patients.		NIPPV avoids endotracheal intubation, reduces the length of the hospital stay, and reduces the in-hospital mortality rate in selected patients.

	==Major Points==		==Major Points==

Ostermayer at 22:05, 7 February 2014

2014-02-07T22:05:32Z

← Older revision		Revision as of 22:05, 7 February 2014
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	\| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJM199509283331301		\| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJM199509283331301
	\| pdfurl= http://www.nejm.org/doi/pdf/10.1056/NEJM199509283331301		\| pdfurl= http://www.nejm.org/doi/pdf/10.1056/NEJM199509283331301
	\| status = ~~Complet~~		\| status = Complete
	}}		}}