Ventilation & weaning · Non-invasive ventilation in COPD exacerbation
Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease
| Design | Randomised controlled trial in intensive care |
|---|---|
| Treatment | Non-invasive ventilation plus standard therapy |
| Control | Standard therapy alone |
| Population | 85 patients with acute exacerbations of COPD, selected from 275 admitted over the same period |
| Follow-up | Hospital admission |
| Primary endpoint | Need for endotracheal intubation |
| Result | Endotracheal intubation was needed in 11 of 43 (26%) with non-invasive ventilation versus 31 of 42 (74%) with standard therapy (p<0.001). Hospital stay was shorter (23±17 versus 35±33 days, p=0.005) and in-hospital mortality lower (9% versus 29%, p=0.02). 85 patients were recruited from 275 admitted over the same period. |
| Secondary endpoints | Length of hospital stay, in-hospital mortality, complications |
In selected patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation, the length of the hospital stay, and the in-hospital mortality rate.
The trial authors, in the published abstract
The trial that created acute non-invasive ventilation as a therapy, and still the strongest indication for it. Note 'selected': 85 of 275 admitted patients were enrolled. NIV in hypercapnic COPD remains the one setting where the evidence is unambiguous — contrast FLORALI and 3CPO in other forms of respiratory failure.
Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995 Sep 28;333(13):817-22.