Which of the following are indications to use noninvasive ventilation (NIV) in patients who have chronic obstructive pulmonary disease (COPD) with nocturnal hypoventilation?

1. PaCO2 greater than 55 mm Hg
2. More than two hospitalizations related to hypercapnic respiratory failure
3. PaCO2 greater than 65 mm Hg
4. PaCO2 between 50 and 54 mm Hg with nocturnal desaturation
a. 1, 2, and 3 only
b. 2 and 4 only
c. 1, 2, and 4 only
d. 1, 3, and 4 only

ANS: C
The current recommendation from a consensus conference is to use NIV in the care of patients with severe COPD who have symptoms of nocturnal hypoventilation and one of the following: PaCO2 of 55 mm Hg or greater, a PaCO2 between 50 and 54 mm Hg with nocturnal desaturation, or more than two hospital admissions related to hypercapnic respiratory failure.