Shrinking the room for invasive mechanical ventilation in acute chronic hypercapnic respiratory failure: yes, but must be sure to have opened windows for noninvasive ventilation

Antonio M Esquinas Rodriguez,¹ Rafaelle Scala,² Nicolino Ambrosino<sup>3

1</sup>International Fellow AARC, Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain; ²Respiratory Ward and Respiratory Intensive Care Unit, S, Donato Hospital, Arezzo, Italy; ³Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Department, University Hospital Pisa, Pisa, Italy

In the last decade, the treatment and prognosis of chronic obstructive pulmonary disease (COPD) patients have been improved by noninvasive ventilation (NIV).¹
However, the choice between invasive mechanical ventilation (IMV) and NIV, is still influenced by several critical factors.² We read with interest the original article and related commentary by Scarpazza et al, reporting a very high NIV success rate in patients with acute hypercapnic respiratory failure due to acute exacerbations of COPD (AECOPD) with related reduction in IMV-associated complications.³ Nevertheless, although NIV represents one of the most important progresses in pulmonary medicine in the last decade, we believe that there are still some unresolved questions.

View original paper by Scarpazza and colleagues.