Comparative Effectiveness

Noninvasive positive pressure ventilation improves COPD patient outcomes

Patients with acute respiratory failure due to severe worsening of chronic obstructive pulmonary disease (COPD) or congestive heart failure have improved outcomes, including mortality and intubation rates, with noninvasive positive pressure ventilation (NPPV) compared to supportive care (hospital support without invasive ventilation) alone, according to a new research review. In the United States, millions of patients are admitted to intensive care each year because of acute respiratory failure. This condition is severe enough to require life support with invasive mechanical ventilation for approximately 800,000 Americans a year, many of whom do not survive. NPPV is increasingly recognized as an alternative to conventional mechanical ventilation for treating acute respiratory failure, and may offer several benefits with minimal side effects for patients suffering from COPD.

Current evidence suggests that NPPV offers potential benefits for patients with acute respiratory failure who are postoperative or post-transplant. In select populations it may facilitate weaning from invasive ventilation, or prevent recurrent respiratory failure after a breathing tube is removed. These findings are generally consistent with previous systematic reviews and clinical guidelines on NPPV. There is a need for more research in patient populations where NPPV has not been rigorously studied, and to better understand how clinician experience, setting, system resources, and patient characteristics affect treatment as part of routine clinical care.

Details on current research on the effectiveness of NPPV can be found in the evidence-based review, Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure from the Effective Health Care Program of the Agency for Healthcare Research and Quality. To access this review and other materials that explore the effectiveness and risks of treatment options for various conditions, visit the Effective Health Care Program Web site, http://www.effectivehealthcare.ahrq.gov.

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