Ventilatory support

Noninvasive ventilation can avoid the need for intubation, and can reduce mortality and length of hospital stay in patients experiencing a COPD exacerbation. It is recommended for COPD exacerbations associated with hypercapnic respiratory failure and acidosis (defined as partial pressure of carbon dioxide [PaCO₂] above 45 mmHg and pH below 7.35) despite optimal therapy (including oxygen therapy titrated to maintain SpO₂ between 88 and 92%). For detailed information about noninvasive ventilation, including contraindications, see here.

After an episode of acute hypercapnic respiratory failure treated with noninvasive ventilation, patients are at high risk of readmission and life-threatening events during the following year. Ensure adequate follow-up and monitoring.

Invasive ventilation can be considered in patients who remain hypercapnic despite appropriate oxygen delivery and optimisation of noninvasive ventilation machine settings.

Close monitoring on a specialist medical ward is necessary for any patient receiving noninvasive ventilation. Management in an intensive care unit is required if the patient is receiving invasive ventilation.