How I Do It Applying non-invasive ventilation in treatment of acute exacerbation of chronic obstructive pulmonary disease using evidence-based interprofessional clinical practice.

When administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease exacerbation in conjunction with guideline recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Identifying patients appropriate for NIV, and subsequently providing close monitoring to determine an improvement in clinical condition involves a team consisting of physician, nurse and respiratory therapist in institutions that successfully implement NIV. We describe to our knowledge the first known evidence-based algorithm speaking to initiation, titration, monitoring, and weaning of NIV in treatment of acute exacerbation of chronic obstructive pulmonary disease that incorporates the necessary interprofessional collaboration among physicians, nurses and respiratory therapists caring for these patients.