ABSTRACT
Initiating NIV in acute exacerbations of COPD 41
The role of NIV after invasive mechanical ventilation 44
Longer term effects of NIV in acute exacerbations of COPD 45
Staffing and costs 45
What sort of ventilator should be used? 46
When should NIV be started? 48
Factors predicting likely failure of NIV in acute exacerbations 48
Where should NIV be performed? 49
Conclusion 51
References 52
An exacerbation of chronic obstructive pulmonary disease (COPD) of sufficient severity to necessitate hospital admission indicates a poor prognosis, carrying a 6-26 per cent mortality.1-3 An 11 per cent increase in hospital mortality has been reported, increasing over the next two months, six months and two years of follow-up to 20 per cent, 33 per cent and 49 per cent, respectively.2 Another study found five-year survival rates of 45 per cent after hospital discharge, which decreased to 28 per cent with any further episode of hospitalization.4 The outcome of invasive mechanical ventilation (IMV) in patients with COPD is disappointing, with reported survivals of between 20 and 50 per cent.5
