High-Intensity NIPPV for Acute COPD Exacerbations?

NIPPV is frequently used in the management of critically ill patients presenting with an acute COPD exacerbation, as NIPPV decreases the rates of intubation and is associated with lower in-hospital mortality.  Typically, "low" intensity NIPPV, whereby inspiratory positive airway pressures less than 18 cm H2O are used. More recently, the use of "high" intensity NIPPV, with IPAPs between 20-30 cm H2O, has been shown to improve gas exchange, ventilatory function, and improve arterial PCO2 values.  In this podcast, we review the HAPPEN Trial, which compared low intensity to high intensity NIPPV on the need for intubation in patients with an acute COPD exacerbation and hypercapnia.