Authors' objectives: The objective of this evidence-based analysis was to examine the effectiveness, safety, and costeffectiveness of noninvasive positive pressure ventilation (NPPV) in the following patient populations: patients with acute respiratory failure (ARF) due to acute exacerbations of chronic obstructive pulmonary disease (COPD); weaning of COPD patients from invasive mechanical ventilation (IMV); and prevention of or treatment of recurrent respiratory failure in COPD patients after extubation from IMV.

Authors' recommendations: NPPV plus UMC versus UMC alone for first line treatment of ARF due to acute exacerbations of COPD - Moderate quality of evidence showed that compared with UMC, NPPV plus UMC significantly reduced the need for endotracheal intubation, inhospital mortality, and the mean length of hospital stay. - Low quality of evidence showed a lower rate of complications in the NPPV plus UMC group compared with the UMC group. NPPV Versus IMV for the Treatment of ARF in Patients Who Have Failed UMC - Due to inconsistent and low to very low quality of evidence, there was insufficient evidence to draw conclusions on the comparison of NPPV versus IMV for patients who failed UMC. NPPV for Weaning COPD Patients From IMV - Moderate quality of evidence showed that weaning COPD patients from IMV using NPPV results in significant reductions in mortality, nosocomial pneumonia, and weaning failure compared with weaning with IMV. - Low quality of evidence showed a nonsignificant reduction in the mean LOS and mean duration of mechanical ventilation in the NPPV group compared with the IMV group. NPPV for the Treatment of ARF in COPD Patients After Extubation From IMV - Low quality of evidence showed a nonsignificant reduction in the rate of reintubation in the NPPV group compared with the UMC group; however, there was inadequate evidence to draw conclusions on the effectiveness of NPPV for the treatment of ARF in COPD patients after extubation from IMV.

Project Status: Completed

Year Published: 2012

URL for published report: http://www.hqontario.ca/en/mas/tech/pdfs/2012/rev_COPD_Ventilation_Acute_March.pdf

URL for additional information: http://www.hqontario.ca/en/mas/mas_ohtas_tech_copd_ventilation_acute_20120313.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care (MAS)