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

Date:
August 17, 2020
Source:
American Thoracic Society
Summary:
Medical researchers have released new clinical practice guidelines
to 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.



FULL STORY ==========================================================================
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:
* use nocturnal NIV in addition to usual care of patients with chronic
stable hypercapnic COPD;
* have patients with chronic stable hypercapnic COPD undergo
screening for
obstructive sleep apnea (OSA) before initiation of long-term NIV;
* avoid initiating long-term NIV during admission for acute-on-chronic
hypercapnic respiratory failure, favoring instead reassessment
for NIV at 2-4 weeks after resolution;
* avoid the use of in-laboratory overnight polysomnography (PSG)
to titrate
NIV in patients with chronic stable hypercapnic COPD who are
initiating NIV, and
* use NIV with targeted normalization of PaCO2 in hypercapnic COPD
patients
on long-term NIV.

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."

========================================================================== Story Source: Materials provided by American_Thoracic_Society. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Madalina Macrea, Simon Oczkowski, Bram Rochwerg, Richard D. Branson,
Bartolome Celli, John M. Coleman, Dean R. Hess, Shandra Lee Knight,
Jill A. Ohar, Jeremy E. Orr, Amanda J. Piper, Naresh M. Punjabi,
Shilpa Rahangdale, Peter J. Wijkstra, Susie Yim-Yeh, M. Bradley
Drummond, Robert L. Owens. Long-Term Noninvasive Ventilation
in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary
Disease. An Official American Thoracic Society Clinical Practice
Guideline. American Journal of Respiratory and Critical Care
Medicine, 2020; 202 (4): e74 DOI: 10.1164/rccm.202006- 2382ST ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200817104256.htm

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