Non-invasive ventilation (NIV) in the management of acute type 2 respiratory
failure in patients with chronic obstructive pulmonary disease (COPD) represents one of the major technical advances in respiratory care over the last decade. The National
Institute for Health and Clinical Excellence (NICE) recommends that NIV be available in all hospitals admitting patients with COPD.This has led to a rapid expansion in the provision of NIV services, with over 90% of UK admitting hospitals offering this intervention. The UK national audit of acute hospital COPD care in 2003, however, suggested that treatment was often applied to patients outside the existing
British Thoracic Society (BTS) inclusion criteria.This document updates the 2002
BTS guidance and provides a specific focus on the use of NIV in COPD patients with acute type 2 respiratory failure. Although a variety of ventilator units are available, most centres now use bi-level positive airways pressure (BiPAP) units and this guideline refers specifically to this form of ventilatory support,although many of the principles encompassed are applicable to other forms of NIV. The guideline has been produced for the clinician caring for COPD patients in the emergency and ward areas of acute hospitals.