Stopping noninvasive ventilation

Acute noninvasive ventilation usually produces rapid improvement.

For patients with exacerbations of chronic obstructive pulmonary disease (COPD), noninvasive ventilation is usually applied throughout the first 24 hours (with breaks for meals) and then overnight for 1 to 2 nights.

For patients with acute cardiogenic pulmonary oedema, continuous positive airway pressure (CPAP) is usually only required for approximately 6 to 12 hours.

Patients can usually be weaned from noninvasive ventilation once dyspnoea has resolved (particularly in patients with acute cardiogenic pulmonary oedema) and arterial blood gases have normalised (particularly in patients with acute hypercapnic COPD).

Most patients admitted to hospital with acute-on-chronic respiratory failure present severely sleep deprived. Following acute noninvasive ventilation, consider assessing ventilation during sleep (eg using pulse oximetry) to determine whether overnight noninvasive ventilation should be continued for extra nights to restore sleep quality.

Long-term noninvasive ventilation can be ceased following end-of-life discussions and palliative care team involvement. For information on withdrawal of noninvasive ventilation in patients with end-stage respiratory failure, see Withdrawal of noninvasive ventilation. Long-term noninvasive ventilation may also be ceased following improvement of the underlying condition (eg extreme weight loss in morbid obesity).