Abstract
Background While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD), the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.
Materials and methods The European Respiratory Society Task Force (TF) committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.
Results The TF committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.
Conclusions Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The TF conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.
Footnotes
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Conflict of interest: Dr. Ergan reports personal fees from Breas, outside the submitted work.
Conflict of interest: Dr. Oczkowski has nothing to disclose.
Conflict of interest: Dr. Rochwerg has nothing to disclose.
Conflict of interest: Dr. Carlucci reports personal fees from RESMED, personal fees from PHILIPS, personal fees from BREAS, outside the submitted work.
Conflict of interest: MC has received lecturing fees on the subject of cough augmentation from Breas Medical, MPR and Phillips.MC is a member of Breas clinical advisory boardMC attended a tele-monitoring development meeting with Resmed
Conflict of interest: Dr. CLINI has nothing to disclose.
Conflict of interest: Dr. Elliott reports personal fees from Philips-Respironics, personal fees from ResMed, personal fees from Fisher and Paykel, outside the submitted work.
Conflict of interest: NH reports unrestricted grants from Fisher Paykel, Philips and Resmed within and outside the direct area of work commented on here with the funds held and managed by Guy's & St Thomas' NHS Foundation Trust; financial support from Philips for development of the MYOTRACE technology that has patent filed in Europe (US patent pending) outside the area of work commented on here; personal fees for lecturing from Philips-Respironics, Philips, Resmed, Fisher-Paykel both within and outside the area of work commented on here with funds held by Guy's & St Thomas' Charity; NH is on the Pulmonary Research Advisory Board for Philips outside the area of work commented on here with the funds for this role held by Guy's & St Thomas' NHS Foundation Trust; NH is Joint Editor-in-Chief for Thorax
Conflict of interest: Dr. Luján reports to be member of the Clinical Advisory Board from Breas and received speaking fees from ResMed and Philips, during the conduct of the study.
Conflict of interest: Jacek Nasilowski
Conflict of interest: Dr. Nava reports personal fees from Breas, personal fees from Philips, grants from Fisher and Paykel, outside the submitted work.
Conflict of interest: Dr. Pépin reports grants from Air Liquide Foundation, grants and personal fees from Agiradom
Conflict of interest: Dr. Pisani reports personal fees and other from Resmed, other from Fisher & Paykel, personal fees from Chiesi, personal fees from Menarini, outside the submitted work
Conflict of interest: Prof. Dr. Storre reports grants and personal fees from Heinen und Löwenstein, grants and personal fees from VitalAire, grants, personal fees and non-financial support from Vivisol GmbH, grants from Weinmann Deutschland, personal fees from Breas Medical, during the conduct of the study; personal fees and non-financial support from Boehringer Ingelheim Pharma, personal fees from SenTec AG, personal fees from Keller Medical GmbH, personal fees from Linde Deutschland, personal fees from Santis GmbH, outside the submitted work.
Conflict of interest: Dr. wijkstra reports grants and personal fees from Philips, grants and personal fees from RESMED, grants from Vital Air, grants from VIVISOL, grants from Goedegebuure, personal fees from Synapse, personal fees from Bresotec, outside the submitted work.
Conflict of interest: Ms Tonia acts as ERS methodologist.
Conflict of interest: Jeanette Boyd has nothing to disclose.
Conflict of interest: Dr. Scala has nothing to disclose.
Conflict of interest: Dr. Windisch reports grants from Weinmann/Germany, grants from Vivisol/Germany, grants from Heinen und Löwenstein/Germany, grants from VitalAire/Germany, grants from Philips/Respironics/USA, during the conduct of the study; personal fees from Companies dealing with mechanical ventilation, outside the submitted work.
Conflict of interest: Dr. Gonzalez has nothing to disclose.
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