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End stage COPD ventilator weaning

Can a COPD patient be weaned from a vent

  1. These same people with CRF can then have exacerbations that cause them to have worsening symptomes and may require hospitalization or even mechanical ventilation as we have discussed above. It may take a bit longer for a COPD patient to be ready to wean, but many have been there and come off the vent just fine. I Care
  2. She's on 2.5 liters a day and triology machine at night. She's only 68. She had a bowel obstruction surgery 4 weeks ago that has just gone down hill. Her lung collapsed and now she has MRSA in her right lung (a lung abscess). She went into respiratory distress three days ago and they had to vent her
  3. The options for end stage lung disease include transplantation and long term invasive ventilation. Other supportive options are pulmonary rehabilitation and palliative care. Maximal inspiratory pressure (MIP) and Paco2 are used as guidelines for weaning. Other vitals should also be stable
  4. Failure of weaning from invasive mechanical ventilation is one of the major clinical problems in COPD patients. In one study these chronically critically ill patients, representing only 3% of the total number of patients admitted to the ICU, used almost 40% of the total patient days of care [ 17 ]

Weaning is the process of gradually reducing the person's reliance on the ventilator. He or she is actively assessed to determine when weaning should begin. This assessment includes a regular determination of the person's capacity to be removed from ventilatory support Whether to simply provide palliative care or to intubate and use mechanical ventilation (MV) in a patient with severe COPD in acute respiratory failure is a difficult decision. The outcome of MV cannot be accurately predicted. Some patients cannot be weaned from the ventilator; those who are weaned often return to chronic severe respiratory disability. It is important that patients participate. Mechanical ventilation in patients with chronic obstructive pulmonary disease and bronchial asthma DH is the main factor explaining the increased intrathoracic pressure, increased work of breathing (WOB), ventilator dependency and weaning It is measured only in patients without active respiratory effort using the end-expiratory. In the case of ventilator weaning, Haas says protocols managed by non-physician health care providers have been around since the late 1990s and have been proposed as a best practice since the release of a clinical practice guideline (CPG) in 2001. Multiple CPGs since have endorsed the concept of a ventilator liberation protocol, most.

Ventilator weaning - COPD Foundatio

Coming off a ventilator with end stage COPD? - Chronic

Palliative care in COPD patients: is it only an end-of

  1. N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients who suffer from acute respiratory failure (ARF) requiring mechanical ventilation are at risk of relapse. It is unknown whether spontaneously breathing patients benefit from retaining a tracheostomy after discharge from the intensive care unit
  2. Simonds, A. K. Ethics and decision making in end stage lung disease. Thorax 58.3 (2003): 272-277. Gadre, Shruti K., et al. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine 97.17 (2018).. Lindenauer, Peter K., et al. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with.
  3. If your COPD is at end stage, it means your treatments may no longer work or that you may not be able to try other procedures that might extend your life.. This is also called stage IV. You might.
  4. Each stage is defined according to the spirometry measurement of FEV1 (the volume of air breathed out in the first second after a forced exhalation). End-stage COPD is considered stage IV, or very severe COPD with an FEV1 of less than or equal to 30%. 3
  5. Chronic obstructive pulmonary disease (COPD) boosted by incomplete emptying of the lungs, leading to air trapping. This promotes a significant intrinsic positive end-expiratory airway et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized.
  6. According to the Chinese Guideline for Mechanical Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease 2007, weaning with T-tube is advised in COPD patients without obvious bronchial-pulmonary infection while replacement by NIV at pulmonary infection control (PIC) window is advised in COPD patients with obvious bronchial-pulmonary infection

While it is known that patients with COPD who require prolonged ventilation (>72 hours) or reintubation have a worse prognosis, 2 Breen et al3 found that the median requirement for ventilatory support was 2 days (mean 3.2 days) and only 13% received ventilatory support for more than 1 week—a finding contrary to the perception that weaning problems are common Ventilation is a process that requires the diligent care of a medical team and a weaning process. If you have a family member or loved one on a ventilator, here are some things you should know: 1. What is a Ventilator? A ventilator is a machine that supports breathing, and is used mainly in a hospital or rehabilitation setting. Medical issues. The progression of chronic obstructive pulmonary disease (COPD) is such that, in its end stages, the potential for acute respiratory failure rises to the point of near-inevitability. When such failure occurs, a question with which providers then wrestle is whether the ventilatory support employed should be of the invasive or noninvasive type

Invasive mechanical ventilation is a means of life support typically reserved as a last option for acute respiratory failure in chronic obstructive pulmonary disease (COPD). Mechanical ventilation in this population is specifically associated with complications including dynamic hyperinflation and barotrauma that can lead to cardiovascular. Thus, patients need not get stuck on the ventilator, as our weaning techniques continue to improve. However, the long-term prognosis for these patients is poor, and end-of-life discussions would be appropriate for all survivors of mechanical ventilation for COPD. Symptom managemen

Intubation and Ventilators for COP

  1. •PEEPi was found to be higher in COPD patients with weaning failure compared with those successfully weaned •Duration of mechanical ventilation was significantly longer in patients with ineffective triggering (>10% of all breaths) compared with those having lower incidence of ineffective triggering Respir Crit Care Med 1997, 155:906-915
  2. weaning process and increases the length of time spent receiving mechanical ventilation. OVERVIEW Weaning is defined as a progressive decline in the amount of ventilatory support that a patient receives from a ventilator. The weaning process includes decreasing ventilator
  3. ute ventilation and unloaded the inspiratory muscles while CPAP, tailored at a value close to PEEP i,dyn, reduced the patients' neuromuscular drive and inspiratory effort without significant effects on the breathing pattern

4. If end stage COPD, may be physiological. Patients may not tolerate PMV use at this time. 5. If no evidence of obstruction etc, provide reassurance, re-education and limit use until patient is more comfortable. PMV Re-assessment: If patient is unable to use the PMV, LIP should be notified to consider rationale for: 1. Trach tube downsizing 2 The longer a person is on a ventilator, the weaker their chest wall muscles become, which makes weaning from the ventilator harder. The aim is to improve the frequency which the patient can stay without the respirator/ventilator. This may initially be two hours on the ventilator and two hours off of it The symptoms of end-stage chronic obstructive pulmonary disease (COPD) include frequent lung infections, difficulty eating, and shortness of breath. Coping methods typically include palliative.

approach to weaning trials, when to cease weaning trials and proceed with life-long support, managing the tracheostomy tube during PMV, and, finally, how to select a suitable mechanical ventilator for PMV. Key words: long-term mechanical ventilation; prolonged mechanical ventilation; weaning; tracheostomy; mechanical ventilation. [Respir Care. The benefits of noninvasive ventilation (NIV) for acute hypercapnic respiratory failure caused by chronic obstructive pulmonary disease (COPD) are well recognized and consequently its use is widespread. Prognostication in advanced COPD is imperfect, limiting accurate identification of 'end-stage' COPD Stage 1: Very mild COPD with a FEV1 about 80 percent or more of normal. Stage 2: Moderate COPD with a FEV1 between 50 and 80 percent of normal. Stage 3: Severe emphysema with FEV1 between 30 and 50 percent of normal. Simply put, as the COPD Stage numbers increase, the lung prognosis and life expectancy with COPD worsens Weaning Copd Patient Off Ventilator. Ventilator via www.daviddarling.info This Is What A Severe Asthma Attack Really Looks Like! via breathinstephen.com ¿cómo Prevenir Lesiones Cutáneas Asociadas A Ventilación via cuidsalud.com My Dad Is In Intensive Care On Bipap For Copd, Should He via intensivecarehotline.co

Hence, the first step in ventilator weaning is to reverse the process that caused the respiratory failure to begin with. However, 20-30% of patients are considered difficult to wean from ventilator. Weaning failure is defined as the failure to pass a spontaneous-breathing trial or the need for reintubation within 48 hours following extubation Why would a patients values drop after a tracheostomy instead of getting better the patient has COPD and is trying to wean off the ventilator? 2 doctor answers • 3 doctors weighed in Would an end stage COPD patient be able to come off ventilator Prognosis in End-Stage COPD. Background Prognostic variables in COPD patients are not well described, thus decision making regarding when to move away from aggressive life-sustaining treatments is challenging. This Fast Fact will review prognostication in patients with advanced COPD. Ambulatory COPD Patients The forced expiratory volume in one.

Intubation and Mechanical Ventilation for COPD - CHES

Video: Mechanical ventilation in patients with chronic

titrated extrinsic positive end-expiratory pressure to avoid dynamic hyperinflation and its attendant consequences. Controlled sedation helps achieve synchrony of triggering, power, and breath timing between patient and ventilator. When feasible, noninvasive ventilation often facilitates the weaning of ventilator-dependent patients with COPD an Exacerbations of chronic obstructive pulmonary disease (COPD) have a negative effect on patients in terms of mortality, 1,2 health related quality of life, and decline in lung function including huge socioeconomic costs on healthcare resources. Exacerbations commonly result in worsening of gas exchange 3 and pulmonary haemodynamics, 4 and are also predictive of admission to hospital A BiPAP machine is a small breathing device that can help a person with COPD to breathe more easily. It can be used at night or when symptoms flare. BiPAP therapy stabilizes air pressure, helping. In patients with chronic obstructive pulmonary disease (COPD), the rate of weaning failure is high (>25%) and results in prolonged mechanical ventilation that increases both morbidity and mortality [1-4].The most common pathophysiologic cause of unsuccessful weaning is thought to be failure of the respiratory muscle pump [].However, some difficult-to-wean COPD patients fail despite initial. Loss of body cell mass is a common and serious problem for patients with end-stage chronic obstructive pulmonary disease (COPD), especially those with emphysema. COPD patients with emphysema have lower body mass indexes and greater depletion of lean body mass than do COPD patients with chronic bronchitis ( 1 )

Chronic obstructive pulmonary disease mechanical ventilation predictive parameters survival weaning Received: October 27 1993 Accepted after revision June 12 1994 Patients affected by chronic obstructive pulmonary diseases (COPD) undergo recurrent episodes of acute exacerbation of their disease, often requiring mechani-cal ventilation (MV) [1] Weaning — Weaning is the process of decreasing the degree of ventilator support and allowing the patient to assume a greater proportion of their own ventilation (eg, spontaneous breathing trials or a gradual reduction in ventilator support). The purpose is to assess the probability that mechanical ventilation can be successfully discontinued Our weaning program focuses on reducing or eliminating dependence on a ventilator for breathing. We have a Respiratory Therapist and Registered Nurses on staff 24/7 to care for the complex needs of our Ventilator patients. For those requiring chronic ventilator services, our program is designed to provide optimum care and comfort. Dialysis Car The Patient with COPD | Deranged Physiology. This is a bog-standard ICU hot case scenario. The patient may be intubated, or (more likely) they will be on NIV. The major issues to consider in this hot case: Weaning from ventilation, and management of bronchospasm and hypercapnea. Ventilation strategy Increased age and cardiorespiratory or neuromuscular co-morbidities make the discontinuation from mechanical ventilation particularly difficult. 6 The weaning success rate differs among studies depending on the case mix, COPD patients being the most difficult to separate from the ventilator.

Best Practices: Ventilator Weaning Protocols - AAR

Acute respiratory distress syndrome (ARDS) is characterized by severe inflammatory response and hypoxemia. The use of mechanical ventilation (MV) for correction of gas exchange can cause worsening of this inflammatory response, called ventilator-induced lung injury (VILI). The process of withdrawing mechanical ventilation, referred to as weaning from MV, may cause worsening of lung. Two randomized studies [33,34] have evaluated the usefulness of noninvasive ventilation (NIV) as a weaning technique.In the study by Nava et al [], 50 COPD patients who failed a T-tube trial after 36-48 h of mechanical ventilation were randomized to either immediate extubation with noninvasive pressure support via a face mask and a standard ventilator, or continued pressure support via an.

Survival to hospital discharge of patients suffering exacerbations of COPD is better than other medical causes for ICU admission. Although non-invasive ventilation (NIV) may prevent progression to tracheal intubation, its failure in most cases should lead to a period of controlled mechanical ventilation aiming for early extubation, possibly supported by NIV and tracheostomy if this fails Introduction. Noninvasive ventilation (NIV) refers to the delivery of ventilatory support or positive pressure into the lungs without an invasive endotracheal airway, 1,2 usually through a mask. This technique has been demonstrated to efficiently improve acute respiratory failure (ARF), avoiding the complications associated with endotracheal intubation (EI) and conventional invasive mechanical. End-stage patients as palliative measure Patients with acute hypercapnic respiratory acidosis secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD) represent the most extensively studied group and the group showing the greatest evidence of benefit. NIV in weaning from invasive ventilation. NIV is being.

How to Know When the End is Near with End Stage COP

Ive never been in the hospital with my COPD only four years ago when they found it due to pneumonia. The only thing i was told by a doctor was could end up on a ventilator after surgery because of a machine breathing for you while your out and sometimes its hard to breath again on your own because of COPD. Thank Getting a stage 4 COPD diagnosis can be terrifying, to say the least. But even though it's sometimes referred to as end stage COPD, it is not the end of your life and it is not a death sentence. At this stage, lung function has declined to about 30% or less of normal (as determined by FEV1 tests) The COVID-19 pandemic has cast a spotlight on ventilators—but few know much about what they do or how they work.. A ventilator pumps air—usually with extra oxygen—into patients' airways when they are unable to breathe adequately on their own. If lung function has been severely impaired—due to injury or an illness such as COVID-19 —patients may need a ventilator An 87-year-old man was hospitalized with acute congestive heart failure. He had a history of heart failure with reduced ejection fraction, severe chronic obstructive pulmonary disease (COPD) with an FEV 1 of 900 ml (22% predicted), and stage III chronic kidney disease. Diuretics were administered, but his renal function worsened, and he was transferred to the intensive care unit A ventilator-dependent 76-year-old female with COPD and dementia of the Alzheimer's type benefitted from a combination of proper medication, adequate sleep, and a regular routine. A 76-year-old female patient was transferred to a long-term rehabilitation facility in Kirtland, Ohio, from another health care facility due to difficulties in.

Acute kidney injury (AKI) worsens the outcome in mechanically ventilated patients. The occurrence of AKI may have an effect on weaning from mechanical ventilation (MV). The purpose of this work is to study the effect of AKI on weaning from MV for chronic obstructive pulmonary disease (COPD) patients with respiratory failure (RF). The study included 100 mechanically ventilated COPD patients. Weaning from mechanical ventilation is the process of reducing ventilatory support, ultimately resulting in a patient breathing spontaneously and being extubated. This process can be achieved rapidly in ∼80% of patients when the original cause of the respiratory failure has improved A client with end-stage chronic obstructive pulmonary disease (COPD) requires bi-level positive airway pressure (BiPAP). A client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: The nurse is. -Typically applied with nasal mask or full face mask and can be used with mechanical ventilation-Positive inspiratory and expiratory pressure-May prevent the need for intubation of end stage COPD patients -Restrictive chest wall disease-Neuromuscular disease-Nocturnal hypoventilation-Reversible impending ventilatory failure: CH The Philips Trilogy Ventilator 100 is intended for pediatric through adult patients weighing at least 5 kg (11 lbs.). The device is intended to be used in a home, institution/hospital, and portable applications such as wheelchairs and gurneys, and may be used for both invasive and non-invasive ventilation

stage of COPD would save lives. Respiratory failure is the most the ventilator, as our weaning tech-niques continue to improve. However, End-of-life care in chronic obstructive pulmonary disease body-mass index, airflow obstruction, dyspnea, and exercise capacity index i 7. ABG should approximate patient's pre-ventilatory blood gases, especially for patients with COPD. C. Weaning Methods 1. Methods used for weaning: a. Traditional method/Trial and error/T-piece trial. The patient is taken completely off the ventilator. b. IMV/SIMV - decreasing the ventilator rate and allowing the patient to breathe spontaneously

Budesonide facilitates weaning from mechanical ventilation

Lung & Respiratory Disorders / COPD: 0: 02-10-2009 09:18 AM: want some advice about coming off a ventilator: PreemiesUK: Lung & Respiratory Disorders / COPD: 2: 02-14-2008 04:27 AM: Father too stubborn to get treatment for emphysema: sawbuck44: Lung & Respiratory Disorders / COPD: 9: 07-08-2006 01:44 PM: end stage copd: cazajacks: Lung. end of expira]on Step 3: Improve I:E raIo (↓RR, ↓VT, ↑flow rate, square wave ) VENT ADJUSTMENTS WEANING FROM THE VENT PCV SIMV PSV Ventilation Oxygenation ACVC pH and PaCO2 PaO2 and SpO2 V T, RR PEEP, FiO2 P insp I:E (↓T I, ↑rise time), RR PEEP, FiO2 PEEP, FiO2 PEEP, FiO2 V T, RR P insp Ensure you have fixed underlying respiratory. Unfortunately, severe COPD is one situation where end tidal CO2 may be misleading. weaning off ventilation. Timing It's generally a reasonable idea to rest the patient on the ventilator for at least ~24 hours in order to allow for diaphragmatic rest. (Even if the patient looks terrific after a few hours on the ventilator, it's generally not a.

my mom has last stage of copd. has been in and out of hospital for past 3 months. she had a mild heart attack on saturday morning. she went to emergency room and they had to put a ventilator in. they did a heart catherization yesterday. she has an enlarged heart and is now being treated for it Mechanical Ventilation Cases. Case 1>> A 55 year-old man with a history of COPD presents to the emergency room with a two day history of worsening shortness of breath which came on following a recent viral infection Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process Copd in hospital on ventilator. My mum was admitted to hospital 3 weeks ago. She has copd (not sure what stage but she didn't use continuous inhalers but has had a few chest infection in the last 2 month and she would get out of breath very eislily) they put her on non invasive ventilation first then changed to the one going in her mouth The role of non-invasive ventilation in the elderly Rationale. NIV is the first-choice ventilatory technique in some diseases (COPD, cardiogenic pulmonary edema, immunosuppression of different origin, neuromuscular disease without severe bulbar impairment, obesity hypoventilation syndrome and chest wall deformity) which have an high prevalence in the elderly []

Ventilator settings— Readings that show how much oxygen the patient receives, how often the ventilator is breathing for the patient, and the depth of each breath. Ventilator— A machine that breathes for the patient. Weaning trials— A process in which the ventilator breathing is slowly cut back to take the patient off the ventilator 0. 50% to 64%. 1. 36% to 49%. 2. Less than 36%. 3. FEV1 is a strong predictor of survival in people with COPD. Those with severe airway obstruction on long-term oxygen therapy have low survival rates (roughly 70% to year one, 50% to year two, and 43% to year three) Still, when a patient's situation sufficiently improves, it may be time to begin the delicate ventilator weaning process, to remove the tube (extubation) and get the patient breathing on.

Noninvasive ventilation as an addition to pulmonary rehabilitation in severe stable COPD. Pulmonary rehabilitation is a well proven effective treatment to improve HRQoL, relieve dyspnoea, reduce exacerbations and improve self-management in patients with symptomatic COPD of any stage [].It is also effective in patients with severe COPD but might be problematic to fulfil as patients experience. Introduction. About 40% of all patients admitted to Intensive Care Units (ICU) require mechanical ventilation, mostly through translaryngeal intubation. 1,2 Most patients can be liberated from mechanical ventilation within one week, a smaller proportion requiring tracheostomy and long periods of weaning from mechanical ventilation. According to different definitions, 3-5 these patients may. There is some debate, for example, about whether feeding tubes actually extend life in end-stage Alzheimer's disease. For many, this is a quality of life issue, and they would prefer to not to live this way. a machine that helps the person breathe. A ventilator requires a tube down a person's throat or through a tracheotomy (hole in the. Case LR had been ventilator dependent since his diagnosis of amyotrophic lateral sclerosis approximately 1 year earlier; his initial presentation and deterioration were so rapid that he was actually placed on a ventilator before his diagnosis of ALS was confirmed. Throughout his illness, LR was clear and consistent about the circumstances that would prompt him to request that he be withdrawn. Chronic obstructive pulmonary disease (COPD) is a chronic disease with high mortality and morbidity worldwide. Patients with end-stage COPD frequently develop chronic hypercapnic respiratory failure (CHRF) associated with end-of-life. In that stage of disease, treatment options are limited. Long-term nocturnal noninvasive ventilation (NIV) has.

Using Non-Invasive Ventilation at the End-of-Life

patient-ventilator synchrony, air leaks, adequate equip-ment and environment, patho-physiology pattern, timing and severity of ARF [10]. Above all, the adherence to the scheduled ventilatory treatment is the crucial ingredi-ent for successfully adapting, carrying on and weaning the patient off from the ventilator [10-12]. As a matte end stage COPD support chronic vent failure restrictive chest wall disease neuromuscular dz during final weaning stage ↑mandatory rate or pressure support IF pt spont breath is inadequate. Pressure Support Ventilation -COPD and vent dependent *rapidly wean the pt ↓the incidence of disuse and atrophy of diaphragm

Introduction. Noninvasive ventilation (NIV) is an established indication in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure (AHRF) with respiratory acidosis [1, 2].Although different studies have defined factors predicting the outcome of NIV in terms of intubation and mortality in patients with severe AHRF [3-6. Introduction. Patients with end-stage COPD can present with hypoxemic and hypercapnic respiratory failure. 1 Long-term oxygen therapy (LTOT) is a well-established, frequently prescribed treatment for hypoxemic respiratory failure that has been reported to improve long-term survival in patients suffering from COPD. 1 Although long-term or home mechanical noninvasive ventilation (Home-NIV) is a. The highest rate of weaning failure has been reported in chronic obstructive pulmonary disease (COPD) patients'2 and may result in prolonged mechanical ventilation, reintubation, tracheostomy. Summary Home mechanical ventilation, as provided by long-term NPPV, is a widely accepted treatment option for many patient groups with chronic hypercapnic respiratory failure, including also those with COPD, even though the rationale for long-term NPPV in COPD patients is still disputed. This is based on clinical observations that conventional NPPV using assisted ventilation and low mean.

Market Analysis: Pulse Oximetry | RT

There is stage 1. There is stage 2. There is stage 3, and there are stage 4. And you can clean this off of a pulmonary function test. If a patient has had a pulmonary function tests, usually you're seeing these patients in the hospital and you don't have access to them. COPD by definition is somebody with an FEV1 / FVC of less than 0.7 (defined as weaning failure or death linked to mechanical ventilation) in the two groups. The probability of weaning failure was significantly lower for the noninvasive ventilation group (cumulative probability for 60 days, P< 0.01 by the log-rank test)

Ventilator weaning protocols have been shown to reduce the duration of mechanical ventilation (MV), intensive care unit length of stay, and resource use. However, weaning protocols have not significantly affected mortality or reintubation rates. The extubation process is a critical component of respiratory care in patients who receive MV. Post-extubation respiratory failure (PERF) is a common. Non-invasive mechanical ventilation has been increasingly used to avoid or serve as an alternative to intubation. Compared with medical therapy, and in some instances with invasive mechanical ventilation, it improves survival and reduces complications in selected patients with acute respiratory failure. The main indications are exacerbation of chronic obstructive pulmonary disease, cardiogenic. COPD heart failure. One of the most critical complications of COPD is heart failure. Because people with COPD have lower levels of oxygen in their bloodstream and because lung function is so. Frequent coughing or wheezing, excess mucus and shortness of breath are hallmark symptoms of chronic obstructive pulmonary disease (), the third leading cause of death in the United States.A.

End-Stage COPD (Stage 4): Symptoms, Treatments, Prognosi

The information on end-stage COPD is based on clinical guidelines COPD-X: concise guide for primary care [Lung Foundation Australia, 2017] and Global initiative for chronic obstructive lung disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2019 report [] and expert opinion in articles [Bloom, 2018; Rothnie, 2018] However, research in Taiwan focused on follow-up medical status for mild or moderate COPD in clinics, or weaning of severe COPD in intensive care unit (ICU). There was no relative research investigating non-invasive ventilator-dependent elderly with COPD on home care 4 be removed from the oxygen. End stage pallative care is difficult because only as estimated 2.6% of patients can successfully weaned off the ventilator. While an estimated 27% will have to eventually be placed back on a ventilator again Thus, we proposed a randomized controlled trial to compare the use of HFNC and noninvasive ventilation (NIV) in weaning COPD. High flow nasal cannula (HFNC) provides high concentration oxygen in a high flow, which exceeds patient's inspiratory flow demand, to improve oxygenation. In a recent meta-analysis of seven trials with 1771 patients. For patients with chronic obstructive pulmonary disease (COPD), the tidal volume and rate are slightly reduced to the 10-10 rule to prevent overinflation, hyperventilation, and auto-positive end-expiratory pressure (PEEP). A tidal volume of 10 mL/kg lean body weight is delivered 10 times a minute in the assist-control mode

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