title: Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance.
abstract: 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.
authors.affiliation: ICU, Azienda Ospedaliera S.Luigi Gonzaga, Orbassano, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Squadrone
authors.forename: Pamela
authors.initials: P
authors.lastname: Frigerio
authors.forename: Claudio
authors.initials: C
authors.lastname: Fogliati
authors.forename: Cesare
authors.initials: C
authors.lastname: Gregoretti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Roberta
authors.initials: R
authors.lastname: Costa
authors.forename: Paola
authors.initials: P
authors.lastname: Baiardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Navalesi
mesh_terms: 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*