Noninvasive Ventilation Often Is Paramount for Severe COPD Exacerbations

Published in JAMA Intern Med 2014 Dec 1; 174:1982

Authors: Lindenauer PK et al.

Compared with invasive ventilation for chronic obstructive pulmonary disease exacerbations, noninvasive positive pressure ventilation was associated with lower in-hospital mortality, length of stay, and cost.

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; Cochrane Database Syst Rev 2004; CD004104). 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).

Comment

Although an NPPV mortality benefit for patients with COPD exacerbations has been proven previously in randomized trials, this large study confirms that benefit in routine clinical practice. NPPV is a guideline-recommended intervention, which should be considered for any patient admitted with a COPD exacerbation who has respiratory acidosis (pH ≤7.35) or severe dyspnea with signs of respiratory fatigue or increased work of breathing.