Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease

Publication Date: August 15, 2020
Last Updated: March 14, 2022

Recommendations

We suggest the use of nocturnal noninvasive ventilation (NIV) in addition to usual care for patients with chronic stable hypercapnic COPD. (C, M)
620
We suggest that patients with chronic stable hypercapnic COPD undergo screening for obstructive sleep apnea before initiation of long-term NIV. (C, VL)
620
We suggest not initiating long-term NIV during an admission for acute-on-chronic hypercapnic respiratory failure, favoring instead reassessment for NIV at 2–4 weeks after resolution. (C, L)
620
We suggest not using an in-laboratory overnight polysomnogram (PSG) to titrate NIV in patients with chronic stable hypercapnic COPD who are initiating NIV. (C, VL)
620
We suggest NIV with targeted normalization of PaCO2 in patients with hypercapnic COPD on long-term NIV. (C, L)
620

Recommendation Grading

Overview

Title

Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease

Authoring Organization

American Thoracic Society

Publication Month/Year

August 15, 2020

Last Updated Month/Year

November 22, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To allow patients, clinicians, policy makers, and other healthcare stakeholders to make rational, evidence-based decisions with regard to the use of long-term NIV in COPD, which are relevant to their local setting.

Target Patient Population

Patients with COPD

Target Provider Population

Clinicians who care for patients with COPD

PICO Questions

  1. Should long-term nocturnal NIV versus usual care be used for chronic stable outpatients with hypercapnic COPD?

  2. Should patients with chronic stable hypercapnic COPD undergo assessment for sleep apnea (i.e., overlap syndrome) before initiation of long-term NIV?

  3. Should long-term NIV be initiated in patients hospitalized with a COPD exacerbation associated with acute-on-chronic respiratory failure?

  4. Should long-term NIV settings be determined by an in-laboratory overnight PSG in patients with chronic stable hypercapnic COPD?

  5. Should NIV with targeted normalization of PaCO2 amounts versus NIV without targeting normal PaCO2 amounts be used for long-term NIV in patients with COPD?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Home health, Long term care

Intended Users

Nurse, nurse practitioner, physician, physician assistant, respiratory therapist

Scope

Management

Diseases/Conditions (MeSH)

D063087 - Noninvasive Ventilation, D029424 - Pulmonary Disease, Chronic Obstructive, D014691 - Ventilation

Keywords

noninvasive ventilation, chronic obstructive pulmonary disease (COPD), COPD, ventilation, NIV

Source Citation

Macrea, M., Oczkowski, S., Rochwerg, B., Branson, R., Celli, B., & Coleman, J. et al. Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202(4): e74-e87. doi: 10.1164/rccm.202006-2382st

Supplemental Methodology Resources

Data Supplement