1. Clinical Case and Discussion Questions
Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease
Clinical Case and Discussion Questions
Created by William E Cayley, Jr
Journal Club Editor
Prevea Family Medicine Residency

2. Gerald
Gerald is a 68 year old man with a 50 pack- year smoking history (approximately 1 pack daily for 50 years).
He has been hospitalized several times in the past year with acute exacerbations of his chronic obstructive pulmonary disease (COPD), often with delirium as a result of high CO2 levels.

3. Gerald
On previous hospitalizations, the admitting physician has ordered non-invasive ventilation (NIV) with bi-level positive airway pressure (BiPAP) on some occasions
However, since Gerald has clearly stated he does not want to be on a “breathing machine”, at other times he has not been given NIV.

4. Gerald
As a teaching physician working with the intern admitting Gerald for another exacerbation of COPD, you are searching for both clinical guidance to enable you to care for him in a way that is in accordance with his stated preferences and a way to make this a “teachable moment” for your trainee.

5. Gerald
While your intern is evaluating Gerald in the emergency room, you search the Cochrane Library for relevant information and find a review titled:
Non-invasive ventilation for the
management of acute hypercapnic
respiratory failure due to exacerbation
of chronic obstructive pulmonary disease

6. Questions for discussion
What does this review tell you about the relative benefits of routine NIV use compared with usual care for patients with hypercapnic acute COPD?
How might you use the information from this review to address Gerald’s request that NIV only be used “if it’s absolutely necessary.”
What will you ask your intern to tell Gerald?

7. Further Information How to cite the Cochrane Review:
Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD DOI: / CD pub4.
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