Inspiratory pressure during noninvasive ventilation in stable COPD: help the lungs, but do not forget the heart.

The disappointing results of the randomised trials on the use of noninvasive ventilation (NIV) in stable hypercapnic chronic obstructive pulmonary disease (COPD) patients [1] necessitates a search for the reasons for NIV inefficiency in long term treatment. WINDISCH et al. [2] suggested that NIV aimed at increasing maximum-tolerated inspiratory positive airway pressure and taking over patients breathing rhythm by a ventilator is a key factor in the success of NIV. The new idea proposed by WINDISCH et al. [3], called high intensity noninvasive positive pressure ventilation (Hi-NPPV), seems to be attractive, but requires verification. Therefore, we would like to congratulate LUKÁCSOVITS et al. [4] on their excellent physiological study of the short-term effects of Hi-NPPV published in the April 2012 issue of the European Respiratory Journal. However, we believe that some aspects of this study need to be critically discussed.