Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance.
OBJECTIVE
To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) meeting criteria for mechanical ventilation.


METHODS
Matched case-control study conducted in ICU.


METHODS
NIV was prospectively applied to 64 COPD patients with advanced ARF. Their outcomes were compared with those of a control group of 64 COPD patients matched on age, FEV(1), Simplified Acute Physiology Score II, and pH at ICU admission, previously treated in the same ICU with conventional invasive mechanical ventilation.


RESULTS
NIV failed in 40 patients who required intubation. Mortality rate, duration of mechanical ventilation, and lengths of ICU and post-ICU stay were not different between the two groups. The NIV group had fewer complications ( P = 0.01) and showed a trend toward a lower proportion of patients remaining on mechanical ventilation after 30 days ( P = 0.056). Compared to the control group, the outcomes of the patients who failed NIV were no different. Compared to the patients who received intubation, those who succeeded NIV had reduced mortality rate and lengths of ICU and post-ICU stay.


CONCLUSIONS
In COPD patients with advanced hypercapnic acute respiratory failure, NIV had a high rate of failure, but, nevertheless, provided some advantages, compared to conventional invasive ventilation. Subgroup analysis suggested that the delay in intubation was not deleterious in the patients who failed NIV, whereas a better outcome was confirmed for the patients who avoided intubation.
Squadrone
Enzo
E
ICU, Azienda Ospedaliera S.Luigi Gonzaga, Orbassano, Italy.
Frigerio
Pamela
P
Fogliati
Claudio
C
Gregoretti
Cesare
C
Conti
Giorgio
G
Antonelli
Massimo
M
Costa
Roberta
R
Baiardi
Paola
P
Navalesi
Paolo
P
D000208:Acute Disease; D000368:Aged; D016022:Case-Control Studies; D003422:Critical Care / Q000592:standards; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D007362:Intensive Care Units; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000592:standards*