Editorial
Predicting the outcome from NIV for acute exacerbations of COPD
| The first 150 words of the full text of this article appear below. |
The use of non-invasive ventilation (NIV) in the management of acute exacerbations of chronic obstructive pulmonary disease (COPD) is now supported by a number of randomised controlled trials.1-5 It has been shown to reduce intubation rates,1 3-5 mortality,1 2-5 and length of stay.1 4 It has the advantage that it can be applied intermittently, avoids the need for sedation, and allows the patient to eat, drink and talk. The incidence of nosocomial pneumonia during NIV is lower than in intubated patients.6-8 NIV has the additional advantage that it can be used with success outside the intensive care unit (ICU), thereby reducing the demand on ICU beds.5
However, NIV is not without its problems. The mask can be uncomfortable
and claustrophobic for an acutely dyspnoeic patient, it can cause
facial skin necrosis and, if poorly fitted, may be associated with
large amounts of leakage which may compromise the efficiency of
ventilation. Gastric distension is
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