Optimal pressures during long-term noninvasive ventilation in patients with COPD

Andreas Freitag

What should be the optimal pressures during long-term noninvasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD)?

Andreas Freitag: I think that is probably one of the reasons why the current line paper that I talked about (see Noninvasive ventilation in long-term treatment of COPD), the positive paper on an outpatient basis, was successful. When they looked at the inspiratory pressures, they were on the order of around between 16 and 20 cm H2O. So your inspiratory positive airway pressure (IPAP) or pressure support was 16 to 20 cm H2O, and their positive end-expiratory pressure (PEEP) was around 6 to 8 cm H2O for the most part. They were able to aggressively scrub down their CO2, almost normalize their CO2, under those circumstances and that seemed to make a difference. So I think it is the titration, the actual prescription, the ventilation dosage to the patient, if you will, that may make a difference.

See also
  • Sedation in patients on noninvasive ventilation What is your opinion on sedation of patients on noninvasive ventilation? In BTS guidelines, sedation with morphine is an optional approach in agitated patients receiving NIV.
  • Prevalence of infections caused by atypical pathogens in CAP Physicians treating patients with CAP tend to overestimate or underestimate the prevalence of infections caused by atypical pathogens. Are there any recent data that could be helpful in identifying patients with atypical infection?
  • Treatment of latent TB infection in patients with rheumatoid arthritis The WHO advocates several regimens for the treatment of latent tuberculosis (TB) infection. Are there any new data comparing different treatments that suggest which regimen would be optimal for adults with rheumatoid arthritis (RA) who have been treated for latent TB infection before starting biologic therapy for RA?
  • Noninvasive ventilation: what nonintensivists should know A lecture by Prof. Andreas Freitag, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2016.
  • Noninvasive ventilation in long-term treatment of COPD There are some data that noninvasive ventilation could be useful in long-term treatment of some patients with COPD. Apart from the information from arterial blood gas analysis, which data should we use to decide which stable hypercapnic patients with COPD will benefit most from NIV? Is there a subgroup of patients in whom this treatment should be routinely used?

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