New practice guidelines on non-invasive ventilation in chronic stable Hypercapnic COPD

August 17, 2020

August 17, 2020 -- A subcommittee of the American Thoracic Society Assembly in Sleep and Respiratory Neurobiology has released new clinical practice guidelinesto help advise clinicians on the optimal management of patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. Hypercapnia is the buildup of carbon dioxide in the bloodstream. The guidelines, published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, is titled "Long-Term Non-Invasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease: An Official American Thoracic Society Guideline."

The committee, comprised of leading clinicians working in pulmonary and critical care medicine, as well as patient representatives, developed a consensus approach and summarized evidence for addressing five PICO (patients, intervention, comparator, outcome) questions related to non-invasive ventilation (NIV) for chronic hypercapnic COPD. Recommendations were formulated by the panel of pulmonary and sleep physicians, respiratory therapists and methodologists using the Evidence-to-Decision framework, a systematic and transparent approach to groups making well-informed health care recommendations.

While NIV is used for patients with COPD and chronic hypercapnia, up to this point, evidence for clinical efficacy and optimal management of therapy have been limited.

"This guideline is needed because patients with severe COPD are very sick and have few therapies that have been shown to improve outcomes," said guideline Chair Robert L. Owens, MD, associate professor, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego. "Clinicians who care for these patients need information about whether to consider non-invasive ventilation and some practical advice on how to set up patients with NIV."

The group's main recommendations are to: To develop each of the recommendations, the panel reviewed results from numerous randomized clinical trials, and looked at such factors as health equity and availability of pulmonary and critical care specialists in medically underserved areas, as well as the likelihood of patient compliance. Because some or all of these issues may impact each of the recommendations, all recommendations were considered conditional. The group outlined unanswered questions for each recommendation, as well as future research directions. They also examined what other specialty organizations were saying on these issues.

"It is exciting to consider NIV as additional therapy for those with hypercapnic COPD," the authors stated. "However, there are many issues to consider."

Among these issues are: appropriate patient selection; implementation barriers; the need for more data to guide the goals of therapy, especially on how clinicians should target PaCO2; addressing regulatory/payor considerations on the ability to obtain home NIV for COPD, and the potential for worsening health care disparities due to the cost and expertise needed to provide NIV for patients with stable hypercapnic COPD.

Dr. Owens concluded, "This guideline is needed now because studies in the last few years have shown improved outcomes with non-invasive ventilation for patients with severe COPD. The guideline incorporates recent studies, while also highlighting priority areas for research."
The ATS has published nearly 20 clinical practice guidelines on various conditions, ranging from allergy and asthma to TB and other pulmonary infections. For ATS guideline implementation tools and derivatives, go here.

American Thoracic Society

Related Sleep Articles from Brightsurf:

Size and sleep: New research reveals why little things sleep longer
Using data from humans and other mammals, a team of scientists including researchers from the Santa Fe Institute has developed one of the first quantitative models that explains why sleep times across species and during development decrease as brains get bigger.

Wind turbine noise affects dream sleep and perceived sleep restoration
Wind turbine noise (WTN) influences people's perception of the restorative effects of sleep, and also has a small but significant effect on dream sleep, otherwise known as REM (rapid eye movement) sleep, a study at the University of Gothenburg, Sweden, shows.

To sleep deeply: The brainstem neurons that regulate non-REM sleep
University of Tsukuba researchers identified neurons that promote non-REM sleep in the brainstem in mice.

Chronic opioid therapy can disrupt sleep, increase risk of sleep disorders
Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine.

'Short sleep' gene prevents memory deficits associated with sleep deprivation
The UCSF scientists who identified the two known human genes that promote 'natural short sleep' -- nightly sleep that lasts just four to six hours but leaves people feeling well-rested -- have now discovered a third, and it's also the first gene that's ever been shown to prevent the memory deficits that normally accompany sleep deprivation.

Short sleep duration and sleep variability blunt weight loss
High sleep variability and short sleep duration are associated with difficulties in losing weight and body fat.

Nurses have an increased risk of sleep disorders and sleep deprivation
According to preliminary results of a new study, there is a high prevalence of insufficient sleep and symptoms of common sleep disorders among medical center nurses.

Common sleep myths compromise good sleep and health
People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.

Sleep tight! Researchers identify the beneficial role of sleep
Why do animals sleep? Why do humans 'waste' a third of their lives sleeping?

Does extra sleep on the weekends repay your sleep debt? No, researchers say
Insufficient sleep and untreated sleep disorders put people at increased risk for metabolic problems, including obesity and diabetes.

Read More: Sleep News and Sleep Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to