NONINVASIVE POSITIVE PRESSURE VENTILATION IN ACUTE RESPIRATORY-FAILURE OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Noninvasive positive pressure ventilation (NPPV) has reemerged as an e ffective strategy for reducing morbidity and mortality associated with acute exacerbations of chronic obstructive pulmonary disease (COPD). During acute respiratory failure, dynamic hyperinflation, intrinsic PE EP, and increased airway resistance result in a mechanical workload th at exceeds inspiratory muscle capacity. NPPV provides augmentation of alveolar ventilation and respiratory muscle rest. Observational, cohor t, and, more recently, randomized controlled trials have demonstrated the ability of NPPV to decrease the need for endotracheal intubation a nd decrease complications and mortality. NPPV performs better in COPD patients without significant comorbid illness. It should be initiated during COPD exacerbations if arterial pH is less than 7.35 or if the p atient is severely distressed. Pressure support ventilation (10-20 cmH (2)O) via face mask is likely the optimal technique and, when successf ul, results in rapid clinical improvement.