Benefits of NIV for COPD-CO2 retainers

Citing previous studies, Augusto Savi, et al lists the following as the advantages of using noninvasive ventilation for chronic obstructive pulmonary disease (COPD) patients presenting with respiratory distress. T

1. Increases tidal volume
2. Improves CO2 elimination
3. Reduces respiratory drive
4. Reduction in treatment failure
5. Lower mortality
6. Fewer complications
7. Lower intubation rate

However, they note the following:

In these patients CO2 elimination was increased but overall ventilation-perfusion mismatch is not changed during NIV.  A more important effect is the unloading of the respiratory muslces, which are often close to fatigue in severe episodes of respiratory failure.  

Furthermore, they note the following regarding the safety of oxygenating these patients:

Crossley et al concluded that CO2-retaining COPD patients following a period of mechanical ventilation with PaO2 in the normal range can safely receive supplemental oxygen without retaining CO2 or a depression of respiratory drive.  A new ventilation-perfusjion relationship is established during ventilation to normoxia, and is not altered by further increasing the FiO2.  Nevertheless, the safety of oxygen supplementation during NIV in CO2-retaining COPD patients is not clear.

So it is quite clear that NPPV greatly benefits COPD patients in respiratory distress, and, likewise, there are no harmful effects of oxygenating them as needed to prevent hypoxia.

References:

1. Savi, Augusto, et al, "Influence of FiO2 During Noninvasive Ventilation in Patients with COPD," Respiratory Care, March, 2014, Volume 59, Number 3, pages 383-387

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