TY - JOUR T1 - BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults JF - Thorax JO - Thorax SP - ii1 LP - ii35 DO - 10.1136/thoraxjnl-2015-208209 VL - 71 IS - Suppl 2 AU - A Craig Davidson AU - Stephen Banham AU - Mark Elliott AU - Daniel Kennedy AU - Colin Gelder AU - Alastair Glossop AU - Alistair Colin Church AU - Ben Creagh-Brown AU - James William Dodd AU - Tim Felton AU - Bernard Foëx AU - Leigh Mansfield AU - Lynn McDonnell AU - Robert Parker AU - Caroline Marie Patterson AU - Milind Sovani AU - Lynn Thomas AU - 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 Soc Y1 - 2016/04/01 UR - http://thorax.bmj.com/content/71/Suppl_2/ii1.abstract N2 - Principles of mechanical ventilationModes of mechanical ventilationRecommendation1. 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 NIVRecommendation2. 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 AHRFRecommendation3. 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 NIVGood 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 NIVRecommendations4. 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 … ER -