ATS GUIDELINES Bundle

Long-Term Noninvasive Ventilation in Stable Hypercapnic Chronic Obstructive Pulmonary Disease

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Treatment ➤ For patients with chronic (FEV 1 /FVC < 0.70 and resting PaCO 2 > 45 mm Hg [not during exacerbation]) hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD): ➤ The ATS suggests the use of nocturnal noninvasive ventilation (NIV) in addition to usual care for patients with chronic stable hypercapnic COPD (conditional recommendation, moderate certainty). ➤ The ATS suggests that patients with chronic stable hypercapnic COPD undergo screening for obstructive sleep apnea before initiation of long-term NIV (conditional recommendation, very low certainty). ➤ The ATS suggests NOT initiating long-term NIV during an admission for acute-on-chronic hypercapnic respiratory failure, favoring instead reassessment for NIV at 2–4 weeks after resolution (conditional recommendation, low certainty). ➤ The ATS suggests NOT using an in-laboratory overnight polysomnogram (PSG) to titrate NIV in patients with chronic stable hypercapnic COPD who are initiating NIV (conditional recommendation, very low certainty). ➤ The ATS suggests NIV with targeted normalization of PaCO 2 in patients with hypercapnic COPD on long-term NIV (conditional recommendation, low certainty).

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