You are here

Article Text

Article menu

This article has a correction. Please see:

BTS guidelines
BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults
Free
  1. A Craig Davidson1,
  2. Stephen Banham1,
  3. Mark Elliott2,
  4. Daniel Kennedy3,
  5. Colin Gelder4,
  6. Alastair Glossop5,
  7. Alistair Colin Church6,
  8. Ben Creagh-Brown7,
  9. James William Dodd8,9,
  10. Tim Felton10,
  11. Bernard Foëx11,
  12. Leigh Mansfield12,
  13. Lynn McDonnell13,
  14. Robert Parker14,
  15. Caroline Marie Patterson15,
  16. Milind Sovani16,
  17. Lynn Thomas17,
  18. BTS Standards of Care Committee Member, British Thoracic Society/Intensive Care Society Acute Hypercapnic Respiratory Failure Guideline Development Group, On behalf of the British Thoracic Society Standards of Care Committee
  1. 1British Thoracic Society, London, UK
  2. 2St James's University Hospital, Leeds, UK
  3. 3Barts Health NHS Trust, London, UK
  4. 4Department of Respiratory Research, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
  5. 5Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  6. 6Department of Respiratory, Scottish Pulmonary Vascular Unit, Glasgow, UK
  7. 7Royal Surrey County Hospital NHS Foundation Trust and Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
  8. 8Academic Respiratory Unit, University of Bristol, Bristol, UK
  9. 9North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
  10. 10University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  11. 11Emergency Department, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Manchester, UK M13 9WL
  12. 12University of Plymouth, Plymouth, UK
  13. 13Department of Physiotherapy, Guy's and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
  14. 14Aintree University Hospital, Liverpool, UK
  15. 15CLAHRC, Imperial College, London, UK
  16. 16Queen's Medical Centre, Nottingham, UK
  17. 17Royal College of Physicians, London, UK
  1. Correspondence to Dr A C Davidson, BTS, 17 Doughty Street, London WC1N 2PL, UK; craigdavidson{at}doctors.org.uk

https://doi.org/10.1136/thoraxjnl-2015-208209

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Summary of recommendations

    Principles of mechanical ventilation

    Modes of mechanical ventilation

    Recommendation

    1. Pressure-targeted ventilators are the devices of choice for acute NIV (Grade B).

    Good practice points

    • Both pressure support (PS) and pressure control modes are effective.

    • Only ventilators designed specifically to deliver NIV should be used.

    Choice of interface for NIV

    Recommendation

    2. A full face mask (FFM) should usually be the first type of interface used (Grade D).

    Good practice points

    • A range of masks and sizes is required and staff involved in delivering NIV need training in and experience of using them.

    • NIV circuits must allow adequate clearance of exhaled air through an exhalation valve or an integral exhalation port on the mask.

    Indications for and contra-indications to NIV in AHRF

    Recommendation

    3. The presence of adverse features increase the risk of NIV failure and should prompt consideration of placement in high dependency unit (HDU)/intensive care unit (ICU) (Grade C).

    Good practice points

    • Adverse features should not, on their own, lead to withholding a trial of NIV.

    • The presence of relative contra-indications necessitates a higher level of supervision, consideration of placement in HDU/ICU and an early appraisal of whether to continue NIV or to convert to invasive mechanical ventilation (IMV).

    Monitoring during NIV

    Good practice points

    • Oxygen saturation should be continuously monitored.

    • Intermittent measurement of pCO2 and pH is required.

    • ECG monitoring is advised if the patient has a pulse rate >120 bpm or if there is dysrhythmia or possible cardiomyopathy.

    Supplemental oxygen therapy with NIV

    Recommendations

    4. Oxygen enrichment should be adjusted to achieve SaO2 88–92% in all causes of acute hypercapnic respiratory failure (AHRF) treated by NIV (Grade A).

    5. Oxygen should be entrained as close to the patient as possible (Grade C).

    Good practice points

    • As gas exchange will improve with increased alveolar ventilation, NIV settings should be optimised before increasing the FiO2.

    • The flow rate of supplemental oxygen may need to be increased when ventilatory pressure is increased to maintain the same SaO2 …

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Linked Articles