A patient with chronic obstructive pulmonary disease (COPD) who is having an exacerbation with hypoxemia can be managed with noninvasive positive pressure ventilation (NPPV). Early use of NPPV in carefully selected patients can prevent further deterioration.


Synonym: noninvasive ventilation (NIV)


Advantages of NPPV when it works:

(1) avoids intubation

(2) avoids complications of mechanical ventilation

(3) reduces admissions to the intensive care unit (ICU)

(4) shortens the hospital stay

(5) reduces costs


Patient selection:

(1) hypoxemia (PaO2 < 60 mm Hg)

(2) arterial pH>= 7.25

(3) hemodynamically stable

(4) absence of acute myocardial infarction or cardiac arrest


A patient responding to NPPV will show within a few hours:

(1) an increase in arterial pH (often the first sign of improvement)

(2) a decrease in arterial PaCO2

(3) an increased PaO2

(4) a decrease in the respiratory rate

(5) decreased breathlessness


Closer monitoring may be needed for a patient with risk factors for deterioration:

(1) advanced COPD

(2) older age

(3) hypotension

(4) renal or other organ failure


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