Fig. 01 -

EU Perspective

Fig. 02 -

Who, How and When

Fig. 03 -

Studies, RCTs & Clinical Experience

Fig. 04 -

Studies, RCTs & Clinical Experience

Fig. 05 -

Clinical Practice

Fig. 06 -

NIV Utilisation

Fig. 07 -

2. Studies, RCTs & Clinical Experience

Fig. 08 -

Mechanisms of Improvement

Fig. 09 -

Three Hypotheses

Fig. 10 -

PaCO₂, PaO₂, mM/1, Epworth Sleepiness

Fig. 11 -

Hypercapnic

Fig. 12 -

3. Studies, RCTs & Clinical Experience

Fig. 13 -

The Negative Study

Fig. 14 -

Negative Pressure

Fig. 15 -

Poor Adherence, Sleep, Trial Failure

Fig. 16 -

Mechanical Ventilation Equipment Photo

Fig. 17 -

The other negative positive trials…

Fig. 18 -

Non-evasive Ventilition Trials

Fig. 19 -

Failed Trials

Fig. 20 -

Low airways pressures, Poor patient selection, Poor Compliance

Fig. 21 -

UK Based Study

Fig. 22 -

Positive Clinical Trial Results

Fig. 23 -

Avcow Trial, Australia

Fig. 24 -

2 year Mortality

Fig. 25 -

Murphy & Hart, Thorax 2014

Fig. 26 -

IPAP / EPAP

Fig. 27 -

4. Studies, RCTs & Clinical Experience

Fig. 28 -

Adequate Nocturnal Ventilatory Control

Fig. 29 -

High vs Low Intensity

Fig. 30 -

Breathing Rate Differientation

Fig. 31 -

Overnight Improvement

Fig. 32 -

Intensity vs Pressure

Fig. 33 -

Difference Between Treatments

Fig. 34 -

High Pressure vs Backup Rate

Fig. 35 -

Randomized Crossover Trial

Fig. 36 -

Null Hypothesis

Fig. 37 -

Respiratory & Ventilator Parameters

Fig. 38 -

Sleep actigraphy

Fig. 39 -

Sleep comfort & quality

Fig. 40 -

Severe Respiratory Insufficiency

Fig. 41 -

Clinical Message

Fig. 42 -

Timing of Initiation

Fig. 43 -

Outcome after AECOPD

Fig. 44 -

UK Data

Fig. 45 -

Unstable vs Stable

Fig. 46 -

Unstable Post AECOPD

Fig. 47 -

Netherlands Trial

Fig. 48 -

Baseline Charachteristics

Fig. 49 -

Kaplan Myer Data

Fig. 50 -

Admission Free Survival at 12 months

Fig. 51 -

Lack of Effect with HMV

Fig. 52 -

What Have We Learnt?

Fig. 53 -

Failure to deliver

Fig. 54 -

Inapporpriate primary outcome

Fig. 55 -

Inapporpriate target population

Fig. 56 -

PaCO₂ vs PaO₂

Fig. 57 -

Failure of the Intervention Itself

Fig. 58 -

Chronic Stable COPD Patients

Fig. 59 -

Non-invasive positive pressure

Fig. 60 -

Advanced disease

Fig. 61 -

Low Emergency admission rate

Fig. 62 -

PaCO2 in HMV group

Fig. 63 -

Subgroup HRQL Analysis

Fig. 64 -

Lower all-cause mortality

Fig. 65 -

Need to Treat

Fig. 66 -

Effect with HMV?

Fig. 67 -

Delivery of the intervention

Fig. 68 -

Delivery of the intervention

Fig. 69 -

Appropriate primary outcome

Fig. 70 -

Appropriate target population

Fig. 71 -

Intervention Clinically Effective

Fig. 72 -

Summary

Fig. 73 -

Who, How, When, Which?

Fig. 74 -

Patient Selection - Current Evidence

Fig. 75 -

Patient Selection - Ongoing Trials

Fig. 76 -

Independent Data Monitoring

Fig. 77 -

Mode of NIV - How?

Fig. 78 -

Mode of NIV - Current Evidence

Fig. 79 -

Timing of Initiation - When?

Fig. 80 -

Timing of Initiation - Current Evidence

Fig. 81 -

Timing of Initiation - Ongoing

Fig. 82 -

Best Outcome - Which?

Fig. 83 -

Best Outcome Measures

Fig. 84 -

Novel Autotitrating Devices

Fig. 85 -

Manuscript Under Review ERJ Quote

Fig. 86 -

Patient flow through trial protocol

Fig. 87 -

Comparisons: Table 1 / Table 2

Fig. 88 -

No difference

Fig. 89 -

Comparisons: Table 1 / Table 3

Fig. 90 -

No difference

Fig. 91 -

Table 4: Comparison of Ventilator settings

Fig. 92 -

First report of application

Fig. 93 -

Conclusion

Fig. 94 -

NIV used in Europe

Fig. 95 -

Affiliations

Fig. 96 -

Summary