What is Noninvasive Ventilation?

How CPAP and BiPAP can treat COPD

CPAP machine
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Noninvasive ventilation is an alternative to invasive, mechanical ventilation for patients who have chronic respiratory insufficiency or respiratory failure and can no longer breathe adequately on their own.

Also known as Noninvasive Positive Pressure Ventilation (NIPPV), noninvasive ventilation assists the patient in taking a full breath and helps to maintain an adequate oxygen supply to the body.

NIPPV provides ventilatory support to a patient through the upper airways. It enhances the breathing process by giving the patient a mixture of air and oxygen from a flow generator through a tightly fitted facial or nasal mask.

How is Noninvasive Ventilation Used in COPD?

Patients with chronic obstructive pulmonary disease, or COPD, are sometimes prescribed noninvasive ventilation, such as CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure), during exacerbations to help them breathe.

Typically associated with sleep apnea treatment, both CPAP and BiPAP deliver pressurized oxygen through an aim mask to the patient’s airways. The pressure prevents the throat muscles from collapsing and restricting airflow. CPAP machines are set to a single level of pressure that remains constant throughout the night, whereas BiPAP has two pressure levels, one for inhaling and one for exhaling.

A 2014 research paper published in the Lancet found NIPPV improved survival rates in patients with COPD. The yearlong randomized multicenter, multinational study found patients with COPD who received noninvasive ventilation had a 36% lower risk of mortality.

Other studies show NIPPV used during acute COPD exacerbations reduce the need for endotracheal intubation, are associated with a lower rate of treatment failure and shorter hospital stays.

When is Noninvasive Ventilation Recommended?

In patients with COPD who are experiencing hypercapnic respiratory failure due to an acute COPD exacerbation, noninvasive positive pressure ventilation can be used in place of endotracheal intubation in select patients.

Your doctor may recommend NIPPV for you if you have moderate to severe dyspnea, tachypnea and hypercarbia, with a pH between 7.25 and 7.35.

Patients should not be treated with NIPPV instead of mechanical ventilation if they are medically unstable because of hypotension, sepsis, hypoxia or other life-threatening systemic illness, have a worsening mental status or excessive secretions that put them at a higher risk of aspiration.

Unlike invasive ventilation, which requires monitoring in the intensive care unit (ICU), noninvasive ventilation can frequently be performed in the general hospital ward, provide the staff is appropriately trained in its use.

Noninvasive ventilation is not appropriate for every patient and is not always successful.

Only your doctor can determine if you are a candidate for noninvasive ventilation.


Gershman AJ, Reddy AJ, Budev MM, Mazzone PJ. Does noninvasive positive pressure ventilation have a role in managing hypercapnic respiratory failure due  to an acute exacerbation of COPD? Cleve Clin J Med. 2008 Jun;75(6):458-461.

Köhnlein T, Windisch W, Köhler D, et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med. 2014 Sep;2(9):698-705.  doi: 10.1016/S2213-2600(14)70153-5.

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