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).
