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Domiciliary long-term non-invasive ventilation in COPD: should we select subgroups with a better likelihood to respond to NIV in subsequent randomised controlled trials?
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The efficacy of non-invasive ventilation (NIV) for severe COPD exacerbation has been unambiguously demonstrated. The study by Struik et al recently published in Thorax1 demonstrates that pursuing nocturnal NIV after acute respiratory failure in patients with COPD exhibiting prolonged hypercapnia >48 h after termination of ventilatory support does not reduce time to readmission or rate of deaths at 1 year. They included a mixed cohort of patients with acute-on-chronic and acute respiratory failures. However, in future studies it may be interesting to select patients with persistent hypercapnia several weeks after the acute exacerbation episode. Nevertheless, long-term …
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