Begum Ergan1,2, Simon Oczkowski3,4,2, Bram Rochwerg3,4, Annalisa Carlucci5, Michelle Chatwin6, Enrico Clini7, Mark Elliott8, Jesus Gonzalez-Bermejo9,10, Nicholas Hart11,12, Manel Lujan13, Jacek Nasilowski14, Stefano Nava15, Jean Louis Pepin16, Lara Pisani15, Jan Hendrik Storre17,18, Peter Wijkstra19, Thomy Tonia20, Jeanette Boyd21, Raffaele Scala22, Wolfram Windisch23. 1. Dept of Pulmonary and Critical Care, Dokuz Eylul University School of Medicine, Izmir, Turkey. 2. The first two authors contributed equally. 3. Dept of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. 4. Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 5. Dept of Pulmonary Rehabilitation, IRCCS-Istituti Clinici Scientifici, Pavia, Italy. 6. Clinical and Academic Dept of Sleep and Breathing, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK. 7. Dept of Medical and Surgical Sciences, University of Modena and Reggio Emilia and University Hospital of Modena, Modena, Italy. 8. Dept of Respiratory Medicine, St James's University Hospital, Leeds, UK. 9. Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France. 10. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France. 11. Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation, London, UK. 12. Centre for Human and Applied Physiological Science, Faculty of Life Sciences and Medicine, School of Basic and Medical BioSciences, Kings College London, London, UK. 13. Service of Pneumology, Hospital de Sabadell Corporació Parc Taulí, Universitat Autònoma de Barcelona, Centro de investigación Biomédica en Red (CIBERES), Sabadell, Spain. 14. Dept of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland. 15. Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy. 16. HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, and EFCR laboratory, Grenoble Alpes University Hospital, Grenoble, France. 17. Dept of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany. 18. Dept of Pneumology, University Medical Hospital, Freiburg, Germany. 19. Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 20. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzterland. 21. European Lung Foundation (ELF), Sheffield, UK. 22. Dept of Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy raffaele_scala@hotmail.com. 23. Dept of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany.
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 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 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 task force 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 task force 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.
BACKGROUND: While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in 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 COPDpatients. MATERIALS AND METHODS: The European Respiratory Society task force 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 task force 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 COPDpatients 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 COPDpatients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPDpatients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPDpatients.
Authors: Nils Jurriaan Kosse; Wolfram Windisch; Aris Koryllos; Alberto Lopez-Pastorini; Denis Piras; Hans-Willi Schroiff; Stephan Eric Straßmann; Erich Stoelben; Sarah Bettina Schwarz Journal: Interact Cardiovasc Thorac Surg Date: 2021-01-22
Authors: Nicholas S Hill; Gerard J Criner; Richard D Branson; Bartolome R Celli; Neil R MacIntyre; Amen Sergew Journal: Chest Date: 2021-07-30 Impact factor: 9.410
Authors: Tim Raveling; Judith Vonk; Fransien M Struik; Roger Goldstein; Huib Am Kerstjens; Peter J Wijkstra; Marieke L Duiverman Journal: Cochrane Database Syst Rev Date: 2021-08-09