Andersson F, Borg S, Jansson SA The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med.. 2002; 96:(9)700-708

Apold J, Rydrych D. Preventing device-related pressure ulcers: using data to guide statewide change. J Nurs Care Qual.. 2012; 27:(1)28-34

Bourke SJ, Burns GP. Respiratory medicine, 9th edn. Oxford: Wiley-Blackwell; 2015

British Lung Foundation. Chronic obstructive pulmonary disease (COPD) statistics. 2019. (accessed 27 November 2019)

Adult non-invasive ventilation audit summary report.London: BTS; 2010

2011 adult non-invasive ventilation (NIV) audit.London: BTS; 2011

NIV audit 2012 (national audit period 1 February – 31 March 2012).London: BTS; 2012

NIV audit 2013 (national audit period 1 February – 31 March 2013).London: BTS; 2013

British Thoracic Society. BTS guideline for oxygen use in healthcare and emergency settings. 2017. (accessed 27 November 2019)

Brochard L, Mancebo J, Wysocki M Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med.. 1995; 333:(13)817-22

Broström A, Fridlund B, Ulander M, Sunnergren O, Svanborg E, Nilsen P. A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea. J Eval Clin Pract.. 2013; 19:(1)173-184

Bülow HH, Thorsager B, Hoejberg JM. Experiences from introducing non-invasive ventilation in the intensive care unit: a 2-year prospective consecutive cohort study. Acta Anaesthesiol Scand.. 2007; 51:(2)165-170

Bustamante-Marin XM, Ostrowski LE. Cilia and mucociliary clearance. Cold Spring Harb Perspect Biol.. 2017; 9:(4)

Carron M, Freo U, Zorzi M, Ori C. Predictors of failure of noninvasive ventilation in patients with severe community-acquired pneumonia. J Crit Care. 2010; 25:(3)540.e9-540.e14

Chatmongkolchart S, Schettino GPP, Dillman C, Kacmarek RM, Hess DR. In vitro evaluation of aerosol bronchodilator delivery during noninvasive positive pressure ventilation: effect of ventilator settings and nebulizer position. Crit Care Med.. 2002; 30:(11)2515-2519

Confalonieri M, Garuti G, Cattaruzza MS Italian noninvasive positive pressure ventilation (NPPV) study group. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J.. 2005; 25:(2)348-355

Costanzo L. Physiology, 4th edn. Philadelphia (PA): Saunders/Elsevier; 2010

Davidson AC, Banham S, Elliott M BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax. 2015; 71:ii1-ii35

Donaldson G, Wedzicha J. The causes and consequences of seasonal variation in COPD exacerbations. International Journal of Chronic Obstructive Pulmonary Disease. 2014; 9:(1)1101-1110

Donaldson GC, Seemungal TAR, Patel IS, Lloyd-Owen SJ, Wilkinson TMA, Wedzicha JA. Longitudinal changes in the nature, severity and frequency of COPD exacerbations. Eur Respir J.. 2003; 22:(6)931-936

Fodil R, Lellouche F, Mancebo J Comparison of patient–ventilator interfaces based on their computerized effective dead space. Intensive Care Med.. 2011; 37:(2)257-262–3

Fung CH, Igodan U, Alessi C Human factors/usability barriers to home medical devices among individuals with disabling conditions: in-depth interviews with positive airway pressure device users. Disabil Health J.. 2015; 8:(1)86-92

Respiratory care, 1st edn. In: Gibson V, Waters D (eds). London: Routledge; 2016

Hall JE. Guyton and Hall textbook of medical physiology, 13th edn. Philadelphia (PA): Saunders; 2015

Hu ST, Yu CC, Lee PS, Tsao LI. Life experiences among obstructive sleep apnoea patients receiving continuous positive airway pressure therapy. J Clin Nurs.. 2014; 23:(1-2)268-278

Kaul S, Stell I, Chinn S, Polkey M, Moxham J. The effect of entrainment site and inspiratory pressure on the delivery of oxygen therapy during non-invasive mechanical ventilation (NIMV) in acute COPD patients. Eur Respir Rev.. 2006; 15:(101)190-191

Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ.. 2003; 326:(7382)185-185

Liu J, Duan J, Bai L, Zhou L. Noninvasive ventilation intolerance: characteristics, predictors, and outcomes. Respir Care. 2016; 61:(3)277-284

Longhini F, Colombo D, Pisani L Efficacy of ventilator waveform observation for detection of patient–ventilator asynchrony during NIV: a multicentre study. ERJ Open Res.. 2017; 3:(4)00075-2017

Marhong J, Fan E. Carbon dioxide in the critically ill: too much or too little of a good thing?. Respir Care. 2014; 59:(10)1597-1605

Mas A, Masip J. Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis.. 2014; 9:837-852

Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S. Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure. Crit Care Med.. 2000; 28:(6)1785-1790

National Confidential Enquiry into Patient Outcome and Death. Acute non-invasive ventilation: inspiring change. 2017. (accessed 27 November 2019)

National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115. 2019. (accessed 27 November 2019)

NHS England. Patient safety alert. Stage one warning. Risk of severe harm and death from unintentional interruption of non-invasive ventilation. 2015. (accessed 27 November 2019)

NHS Medical Directorate. COPD commissioning toolkit: a resource for commissioners. 2012. (accessed 27 November 2019)

Newcastle upon Tyne Hospitals NHS Foundation Trust. Policy on the recognition and management of red flag sepsis (ratified by the Clinical Policy Group). 2017. (accessed 27 November 2019)

Nolan J. Advanced life support, 7th edn. London: Resuscitation Council UK; 2016

O'Driscoll BR, Howard LS, Davison AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008; 63:vi1-vi68

Olivieri C, Costa R, Conti G, Navalesi P. Bench studies evaluating devices for non-invasive ventilation: critical analysis and future perspectives. Intensive Care Med.. 2012; 38:(1)160-167

Oostenbrink JB, Rutten-van Mölken MPMH. Resource use and risk factors in high-cost exacerbations of COPD. Respir Med.. 2004; 98:(9)883-891

Ozsancak A, Sidhom SS, Liesching TN, Howard W, Hill NS. Evaluation of the total face mask for noninvasive ventilation to treat acute respiratory failure. Chest. 2011; 139:(5)1034-1041

Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000; 355:(9219)1931-1935

Rathore FA, Ahmad F, Zahoor MUU. Case report of a pressure ulcer occurring over the nasal bridge due to a non-invasive ventilation facial mask. Cureus.. 2016; 8:(10)

Rochwerg B, Brochard L, Elliott MW Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J.. 2017; 50:(2)

Rohde G, Wiethege A, Borg I Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax. 2003; 58:(1)37-42

Salepci B, Caglayan B, Kiral N CPAP adherence of patients with obstructive sleep apnea. Respir Care. 2013; 58:(9)1467-1473

Smith TA, Davidson PM, Jenkins CR, Ingham JM. Life behind the mask: the patient experience of NIV. Lancet Respir Med.. 2015; 3:(1)8-10

Stygall G, Morley K, Pickup L P73 acute non invasive ventilation (NIV)–related nasal bridge pressure ulceration: effect of a proactive prevention approach. Thorax. 2016; 71:A124.2-A125

Vestbo J, Hurd SS, Agustí AG Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med.. 2013; 187:(4)347-365

Weng MH. The effect of protective treatment in reducing pressure ulcers for non-invasive ventilation patients. Intensive Crit Care Nurs.. 2008; 24:(5)295-299

Willman M, Igelström H, Martin C, Åsenlöf P. Experiences with CPAP treatment in patients with obstructive sleep apnea syndrome and obesity. Adv Physiother.. 2012; 14:(4)166-174

Woodrow P. Intensive care nursing, 1st edn. Hoboken (NJ): Taylor & Francis; 2011

World Health Organization. Chronic obstructive pulmonary disease (COPD). Fact sheet. 2017. (accessed 27 November 2019)

Yang MC, Lin CY, Lan CC Factors affecting CPAP acceptance in elderly patients with obstructive sleep apnea in Taiwan. Respir Care. 2013; 58:(9)1504-1513

The use of non-invasive ventilation in an exacerbation of chronic obstructive pulmonary disease: a case study

12 December 2019
Volume 28 · Issue 22


This article aims to assist nurses and other health professionals to care for patients who have type 2 respiratory failure as a result of chronic obstructive pulmonary disease, and who require non-invasive ventilation. It outlines findings of a case study that are commonplace in the acute medical setting and aims to highlight important factors that impact on patient care and patient outcome, and to help nursing staff to implement recommended and best practices.

High numbers of patient with an exacerbation of chronic obstructive pulmonary disease (COPD) present to emergency assessment units, especially in the winter months (Donaldson and Wedzicha, 2014). Management of these patients will depend on the severity of presentation and is often compromised by the relentless pace and workload of these clinical areas. Such patients may be treated by nurses who do not have a sound knowledge of some of the key aspects of treatment and pathophysiology.

This article explores the care of one such patient, who presented with an exacerbation of COPD, noting his functional status, medical history and symptoms, his respiratory biochemistry and concurrent pathophysiology. It will follow one COPD patient's journey through the acute setting and focuses on decisions made that aimed to improve his condition, and the variables encountered that impacted negatively. The study identifies published best practice, and reveals typical actual practice in order to demonstrate how to improve patient outcomes and safety.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content