NIPPV Guidelines for Acute Hypercapnic Respiratory Failure

Patient Selection and Initiation

The British Thoracic Society recommends initiating NIPPV using bi-level pressure support with starting settings of IPAP 10-15 cmH₂O and EPAP 4-5 cmH₂O for acute exacerbations of COPD with persistent respiratory acidosis 1
The British Thoracic Society suggests that primary indication for NIPPV is COPD patients with respiratory acidosis persisting after maximum medical treatment and controlled oxygen therapy 1
The British Thoracic Society indicates that additional indications for NIPPV include chest wall deformity, neuromuscular disorders, decompensated obstructive sleep apnea, and cardiogenic pulmonary edema unresponsive to CPAP 1

The British Thoracic Society recommends bi-level pressure support ventilators for setting up acute NIV services due to simplicity, cost-effectiveness, and flexibility 1
The British Thoracic Society suggests using a full-face mask initially in acute settings, changing to a nasal mask after 24 hours as the patient improves 1

The American Academy of Sleep Medicine recommends starting IPAP at 10-15 cmH₂O 5
The American Academy of Sleep Medicine suggests starting EPAP at 4-5 cmH₂O 5

The British Thoracic Society recommends performing arterial blood gas analysis at 1-2 hours after initiating NIPPV to assess pH, PaCO₂, and PaO₂ response 3
The British Thoracic Society suggests that failure criteria for NIPPV include deterioration of PaCO₂ and pH after 1-2 hours on optimal settings 3

The British Thoracic Society recommends ICU/HDU for patients with pH <7.25 or those at high risk of deterioration 1
The British Thoracic Society suggests that a respiratory ward is acceptable for less severe cases (pH 7.25-7.35) with appropriate nursing ratios and monitoring 1

The European Respiratory Society indicates that delayed intubation is a main risk of NIPPV for acute respiratory failure, which increases mortality 8