Acute respiratory failure arising during an acute exacerbation of chronic obstructive pulmonary disease (COPD) — particularly when accompanied by acute hypercarbia — requires a targeted respiratory support strategy to restore adequate oxygenation while avoiding further CO₂ retention.
This protocol applies to patients with underlying chronic obstructive pulmonary disease who develop acute respiratory failure in the setting of an acute exacerbation accompanied by acute hypercarbia. The combination of obstructive physiology and CO₂ retention defines the critical management challenge in these patients.
The clinical goal is to achieve an SaO₂ of 88% to 92% — a range considered an adequate oxygenation target in this population, balancing the risk of hypoxaemia against the risk of hypercapnic drive suppression.
ERS/ATS guidelines support a non-invasive positive pressure ventilation strategy for this scenario. The recommended intervention involves bilevel airway pressure support — the specific parameters, titration approach, and monitoring criteria are detailed in the full protocol.
DOI: 10.1186/s40560-023-00658-3
The European Respiratory Society (ERS)/ATS guidelines recommend bilevel positive airway pressure (bilevel-PAP) for patients with acute exacerbation of COPD accompanied by acute hypercarbia, CPAP for cardiogenic pulmonary edema, and NPPV for post-operative setting and early ARF in immunosuppressed patients.
In patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), an SaO2 of 88% to 92% is considered an adequate oxygenation target, as suggested by a recent observational study.
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