Non-invasive ventilation for COPD

Indication: The acute decompensated hypercapnic respiratory acidosis of the COPD (the pH 7.28, the raised carbon dioxide) — the BiPAP is the first-line, and it reduces the mortality, the intubation rate, and the length of stay.^[1][2]

Contraindication check: The conscious and the cooperative, the ability to protect the airway, the no facial trauma, the no vomiting or the bowel obstruction, the no pneumothorax (the chest radiograph to exclude).^[4]

Setup:

• The interface — the full-face mask (the least leak in the acute).
• The mode — the BiPAP (the bilevel). The IPAP around 10 to 15, the EPAP around 4 to 5, titrated upward to the response and the tolerance.^[1]
• The FiO2 to the target saturation of 88 to 92 per cent (the controlled, the avoidance of the CO2 narcosis).
• The continuation of the bronchodilators and the steroids.

Monitoring: The continuous — the oxygen saturation, the comfort, the respiratory rate, the blood pressure. The arterial blood gas at the 1 to 2 hours for the response — the rising pH and the falling carbon dioxide confirm the success.^[1]

The failure: If the acidosis worsens, the hypoxia refractory, the exhaustion, or the consciousness drops — the intubation (the no delay).^[1][2]

Disposition: The high-dependency or the intensive care, the gradual wean of the BiPAP as the acidosis resolves.^[1]