Noninvasive ventilation, referring to the provision of mechanical ventilatory assistance without the need for an invasive airway, has been assuming increasing importance in the management of chronic obstructive pulmonary disease (COPD). Particularly in the acute arena, where a number of randomized, controlled trials have demonstrated the efficacy of noninvasive positive-pressure ventilation (NPPV) in averting the need for intubation, noninvasive ventilation is now seen as the first choice mode of ventilation for the therapy of selected patients suffering from COPD exacerbations. Despite numerous studies spanning decades using different types of nonivasive ventilators and all manner of ventilator regimens, however, the use of noninvasive ventilation for patients with severe stable COPD remains controversial. The following discussion focuses on the use of noninvasive ventilation for patients with severe COPD in the subacute and stable settings, paying little attention to the acute setting. For more information on acute applications, the reader is referred elsewhere.<sup>2 American Respiratory Care Foundation Consensus Conference: Noninvasive positive pressure ventilation Respir Care 1997 ;  42 : 364-369

Cliccare qui per andare alla sezione Riferimenti, 29 Hill N.S. Current concepts in mechanical ventilation for chronic obstructive pulmonary disease Semin Respir Crit Care Med 1999 ;  20 : 375-393  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The following discussion includes the physiologic bases for the use of noninvasive ventilation in severe COPD, evidence for (or against) efficacy, possible indications and selection guidelines, newer possible uses, and practical application as it applies to patients with COPD.