Noninvasive Ventilation for Severe Exacerbations of COPD

Noninvasive ventilation (NIV) can be used for patients with chronic obstructive pulmonary disease (COPD), and previous reports have demonstrated a survival benefit when NIV is used in carefully selected patient populations. Lindenauer and colleagues sought to compare the outcomes for patients with COPD treated with NIV versus invasive mechanical ventilation (IMV) using data from a network of U.S. hospitals reporting to a voluntary, fee-supported quality improvement database.

The authors found that patients with COPD treated with NIV at the time of hospitalization had lower inpatient mortality, shorter length of stay and lower costs compared to those treated with IMV. A major strength of this study is the use of a large, externally generalizable population. As with all observational studies, however, residual confounding remains a methodological flaw, which the authors attempted to control for with advanced statistical techniques. All said, among patients hospitalized for COPD exacerbations, NIV seems to be a prudent initial choice for ventilatory support based on the results of this study.

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