Does noninvasive positive pressure ventilation have a role in managing hypercapnic respiratory failure due to an acute exacerbation of COPD?

Yes. In selected patients with hypercapnic respiratory failure due to an acute exacerbation of chronic obstructive pulmonary disease (COPD), noninvasive positive pressure ventilation (NIPPV) is an effective adjunct to usual medical therapy. In controlled trials, it reduced the need for endotracheal intubation, the length of hospital stay, and the risk of death. Acute COPD exacerbations are responsible for more than 500,000 hospitalizations yearly in the United States, and 6% to 34% of patients die.1 Many patients need invasive ventilatory assistance via an endotracheal tube, but such therapy puts the patient at risk of ventilatorassociated pneumonia, pneumothorax, and tracheal stenosis.