Invasive ventilation for COPD patients

Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study. Wildman et el. BMJ December 2007.

I think this paper has raised the profile of whether or not to invasively ventilate patients with an exacerbation of COPD. However the paper only includes the prognosis of patients actually admitted to critical care. This means that the pessimisim in these patients was not great enough for them not to be addmitted at all. Whilst a randomised trial including all patients with an exacerbation would be unethical this is a problem with the study.

Dr. Hina Pattani

Non Invasive Ventilation in Acute Cardiogenic Pulmonary Edema

Non-Invasive Ventilation in Acute cardiogenic Pulmonary Edema. Gray, A et al. NEJM, 2008. 359: 142-51. (or here on pubmed)

The “3 interventions in Cardiogenic Pulmonary oedema trial (3CPO)” trail was a multicentre, open, prospective randomised trial. 1069 patients were randomised over 4 years in 23 different centres in the UK. 3 treatment arms, all targeted to achieve sats >92%. 1: Oxygen, 2: CPAP 5-15cmH20 and 3: BiPAP 8-20/4-10.

Previous trials have suggested a reduction in intubation rates and a mortality benefit for CPAP or NIV, but some concerns over an increased MI rate with NIV.