European Respiratory Society Guideline on Long-term Home Non-Invasive Ventilation for Management of Chronic Obstructive Pulmonary Disease.

Ergan, Begum; Oczkowski, Simon; Rochwerg, Bram; Carlucci, Annalisa; Chatwin, Michelle; Clini, Enrico; Elliott, Mark; Gonzalez-Bermejo, Jesus; Hart, Nicholas; Lujan, Manel; Nasilowski, Jacek; Nava, Stefano; Pepin, Jean Louis; Pisani, Lara; Storre, Jan Hendrik; Wijkstra, Peter; Tonia, Thomy; Boyd, Jeanette; Scala, Raffaele and Windisch, Wolfram (2019). European Respiratory Society Guideline on Long-term Home Non-Invasive Ventilation for Management of Chronic Obstructive Pulmonary Disease. European respiratory journal, 54(3), p. 1901003. European Respiratory Society 10.1183/13993003.01003-2019

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BACKGROUND

While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD), the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.

MATERIALS AND METHODS

The European Respiratory Society Task Force (TF) committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.

RESULTS

The TF committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.

CONCLUSIONS

Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The TF conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

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