title: Lights and shadows of non-invasive mechanical ventilation for chronic obstructive pulmonary disease (COPD) exacerbations.
abstract: Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV) for providing ventilatory support in chronic obstructive pulmonary disease (COPD) exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1) NIV is not invariably available, 2) its availability depends on countries and hospital sizes, and 3) numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year. Even with an established indication, the use of NIV in acute respiratory failure due to COPD exacerbations faces important challenges. First, the location and personnel using NIV should be carefully selected. Second, the use of NIV is not straightforward despite the availability of technologically advanced ventilators. Third, NIV therapy of critically ill patients requires a thorough knowledge of both respiratory physiology and existing ventilatory devices. Accordingly, an optimal team-training experience, the careful selection of patients, and special attention to the selection of devices are critical for optimizing NIV outcomes. Additionally, when applied, NIV should be closely monitored, and endotracheal intubation should be promptly available in the case of failure. Another topic that merits careful consideration is the use of NIV in the elderly. This patient population is particularly fragile, with several physiological and social characteristics requiring specific attention in relation to NIV. Several other novel indications should also be critically examined, including the use of NIV during fiberoptic bronchoscopy or transesophageal echocardiography, as well as in interventional cardiology and pulmonology. The present narrative review aims to provide updated information on the use of NIV in acute settings to improve the clinical outcomes of patients hospitalized for COPD exacerbations.
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla ; Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lopez-Campos
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla.
authors.forename: Luis
authors.initials: L
authors.lastname: Jara-Palomares
authors.affiliation: Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain ; Department of Medicine, Pulmonology Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Muñoz
authors.affiliation: Departamento de Medicina, Servicio de Neumología, Hospital Universitario Basurto, Osakidetza, EHU-University of the Basque Country, Biscay, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Bustamante
authors.affiliation: Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain ; Department of Pulmonology, Muscle Research and Respiratory System Unit Institut Hospital del Mar d'Investigacions Médiques Hospital del Mar, Barcelona, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Barreiro
keywords: COPD; exacerbations; non-invasive ventilation
references.citation: Arch Bronconeumol. 2013 Jun;49(6):275-6
references.pmid: 23332613
references.citation: Int J Clin Pract. 2012 May;66(5):434-7
references.pmid: 22512604
references.citation: Ann Emerg Med. 2014 May;63(5):600-607.e1
references.pmid: 24342819
references.citation: Eur Respir J. 2014 Mar;43(3):754-62
references.pmid: 23988775
references.citation: Arch Bronconeumol. 2014 Aug;50(8):311-2
references.pmid: 24703817
references.citation: Arch Bronconeumol. 2013 Nov;49(11):468-74
references.pmid: 23856439
references.citation: Arch Bronconeumol. 2013 Aug;49(8):330-6
references.pmid: 23856438
references.citation: Int J Tuberc Lung Dis. 2013 Jan;17(1):131-6
references.pmid: 23114257
references.citation: BMJ. 2003 May 3;326(7396):956
references.pmid: 12727767
references.citation: Respir Care. 2004 Mar;49(3):295-303
references.pmid: 14982651
references.citation: Arch Bronconeumol. 2014 Aug;50(8):318-24
references.pmid: 24576449
references.citation: Int J Clin Pract. 2009 Mar;63(3):486-93
references.pmid: 19222634
references.citation: Arch Bronconeumol. 2005 Sep;41(9):505-12
references.pmid: 16194514
references.citation: Thorax. 1998 Oct;53(10 ):863-6
references.pmid: 10193373
references.citation: Int J Chron Obstruct Pulmon Dis. 2007;2(4):471-6
references.pmid: 18268921
references.citation: Ont Health Technol Assess Ser. 2012;12(8):1-102
references.pmid: 23074436
references.citation: Arch Bronconeumol. 2014 Jul;50(7):272-7
references.pmid: 24507558
references.citation: Minerva Anestesiol. 2012 Jul;78(7):842-6
references.pmid: 22580593
references.citation: Arch Bronconeumol. 2014 Oct;50(10):452-3
references.pmid: 24411928
references.citation: Thorax. 2000 Oct;55(10):819-25
references.pmid: 10992532
references.citation: Chest. 2013 Oct;144(4):1163-78
references.pmid: 23722528
references.citation: Heart Lung. 2013 May-Jun;42(3):163-70
references.pmid: 23535142
references.citation: Arch Bronconeumol. 2013 Jun;49(6):223-9
references.pmid: 23317767
references.citation: Eur Respir J. 2011 Aug;38(2):440-9
references.pmid: 21349915
references.citation: Arch Bronconeumol. 2014 Jul;50(7):265-6
references.pmid: 24534196
references.citation: Arch Bronconeumol. 2012 Oct;48(10):349-54
references.pmid: 22705258
references.citation: Emerg Med (Fremantle). 2002 Sep;14 (3):281-95
references.pmid: 12487046
references.citation: Monaldi Arch Chest Dis. 2006 Sep;65(3):145-51
references.pmid: 17220104
references.citation: Arch Bronconeumol. 2014 Jan;50 Suppl 1:1-16
references.pmid: 24507959
references.citation: Lancet. 2000 Jun 3;355(9219):1931-5
references.pmid: 10859037
references.citation: Eur J Echocardiogr. 2010 Jul;11(6):554-6
references.pmid: 20185524
references.citation: PLoS One. 2012;7(7):e42156
references.pmid: 22911875
references.citation: Lancet. 2012 Dec 15;380(9859):2095-128
references.pmid: 23245604
references.citation: Crit Care Med. 1999 Oct;27(10):2266-71
references.pmid: 10548219
references.citation: Thorax. 2010 Nov;65(11):956-62
references.pmid: 20871122
references.citation: Arch Bronconeumol. 2014 Jan;50(1):10-7
references.pmid: 24332830
references.citation: Z Gerontol Geriatr. 2014 Jun;47(4):288-92
references.pmid: 24803019
references.citation: Eur Respir J. 2000 Jan;15(1):98-104
references.pmid: 10678628
references.citation: Lancet. 2009 Jul 18;374(9685):250-9
references.pmid: 19616722
references.citation: Eur Respir J. 2014 Mar;43(3):725-34
references.pmid: 24114962
references.citation: Thorax. 2002 Mar;57(3):192-211
references.pmid: 11867822
references.citation: J Cardiothorac Vasc Anesth. 2013 Dec;27(6):e78-81
references.pmid: 24267579
references.citation: Am J Respir Crit Care Med. 2013 Feb 15;187(4):347-65
references.pmid: 22878278
references.citation: Arch Bronconeumol. 2014 Apr;50(4):129-34
references.pmid: 24268434
references.citation: Med Clin (Barc). 2003 Mar 8;120(8):281-6
references.pmid: 12636896
references.citation: Resuscitation. 2002 Mar;52(3):265-8
references.pmid: 11886731
references.citation: Thorax. 2011 Jan;66(1):43-8
references.pmid: 21075776
references.citation: Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):807-13
references.pmid: 10712326
references.citation: J Crit Care. 2004 Jun;19(2):82-91
references.pmid: 15236140
references.citation: Respir Med. 2013 Dec;107(12):1977-85
references.pmid: 23890959
references.citation: Clin Chest Med. 2014 Mar;35(1):251-69
references.pmid: 24507850
references.citation: Respir Med. 2005 Jul;99(7):894-900
references.pmid: 15939252
references.citation: Intensive Crit Care Nurs. 2011 Aug;27(4):211-7
references.pmid: 21665473
references.citation: Lancet Respir Med. 2014 Sep;2(9):698-705
references.pmid: 25066329
references.citation: Med Clin (Barc). 2014 Jul 22;143(2):78-84
references.pmid: 24054776
references.citation: Thorax. 2013 Dec;68(12):1169-71
references.pmid: 23729193
references.citation: Arch Bronconeumol. 2014 May;50(5):179-84
references.pmid: 24447429
references.citation: Arch Bronconeumol. 2013 Nov;49(11):475-9
references.pmid: 23347549
references.citation: Arch Bronconeumol. 2013 Sep;49(9):383-7
references.pmid: 23791383
references.citation: Monaldi Arch Chest Dis. 2001 Jun;56(3):248-53
references.pmid: 11665505
references.citation: Int J Chron Obstruct Pulmon Dis. 2014 Jun 06;9:597-611
references.pmid: 24944511
references.citation: Arch Bronconeumol. 2013 Mar;49(3):105-12
references.pmid: 22819004
references.citation: Int J Chron Obstruct Pulmon Dis. 2011;6:253-7
references.pmid: 21814461
references.citation: Int J Chron Obstruct Pulmon Dis. 2013;8:231-8
references.pmid: 23687444
references.citation: Eur Respir J. 1996 Jun;9(6):1240-5
references.pmid: 8804944