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

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Key Points ➤ Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world and is the fourth leading cause of death in the United States. ➤ To date, the only therapeutic interventions known to reduce mortality in COPD are smoking cessation and long-term treatment with continuous supplemental oxygen for patients who have severe hypoxemia at rest. ➤ Recently, interest in the use of noninvasive ventilation (NIV) in chronic hypercapnic COPD has been renewed with studies of so-called "high- intensity" NIV, which refers to inspiratory pressures higher than those used in most previous randomized controlled trials (RCTs) as well as controlled ventilation with higher-than-baseline respiratory rates to maximally reduce the PaCO 2 . Application of Guideline Recommendations for Different Stakeholders Strong Recommendation ("e ATS recommends...") Conditional Recommendation ("e ATS suggests...") For Patients Most individuals in this situation would want the recommended course of action, and only a small proportion would not. e majority of individuals in this situation would want the suggested course of action, but many would not. For Clinicians Most individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. Different choices are likely to be appropriate for different patients and therapy should be tailored to the individual patient's circumstances. ose circumstances may include the patient's or family's values and preferences. For Policy makers e recommendation can be adapted as policy in most situations, including for use as performance indicators. Policy making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place. ese guidelines were created using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) Working Group criteria.

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