title: Noninvasive positive-pressure ventilation to treat hypercapnic coma secondary to respiratory failure.
abstract: BACKGROUND
  Hypercapnic coma secondary to acute respiratory failure (ARF) is considered to be a contraindication to the use of treatment with noninvasive positive-pressure ventilation (NPPV). However, intubation exposes these patients to the risk of complications such as nosocomial pneumonia, sepsis, and even death.
  
  
  METHODS
  We performed a prospective, open, noncontrolled study to assess the outcomes of NPPV therapy in patients with a Glasgow coma scale (GCS) score of </= 8 points due to ARF. The primary goal of the study was to determine the success of NPPV therapy (defined as a response to therapy allowing the patient to avoid endotracheal intubation, and to survive a stay in the ICU and at least 24 h on a medical ward) in patients with hypercapnic coma, compared to those who started NPPV therapy while awake. The secondary goal of the study was to identify the variables that can predict a failure of NPPV therapy in these patients.
  
  
  RESULTS
  A total of 76 coma patients (80%) responded to NPPV therapy, and 605 patients with GCS scores > 8 responded to therapy (70%; p = 0.04). A total of 25 coma patients died in the hospital (26.3%), and 287 noncoma patients died in the hospital (33.2%; p = 0.17). The variables related to the success of NPPV therapy were GCS score 1 h posttherapy (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.53 to 3.53) and higher levels of multiorgan dysfunction, as measured by the maximum sequential organ failure assessment index score reached during NPPV therapy (OR, 0.72; 95% CI, 0.55 to 0.92).
  
  
  CONCLUSIONS
  We concluded that selected patients with hypercapnic coma secondary to ARF can be treated as successfully with NPPV as awake patients with ARF.
authors.affiliation: Intensive Care Unit, Hospital Morales Meseguer, C/Marqués de los Velez s/n, 30008 Murcia, Spain. gumersindoj.gonzalez@carm.es
authors.forename: Gumersindo Gónzalez
authors.initials: GG
authors.lastname: Díaz
authors.forename: Andres Carrillo
authors.initials: AC
authors.lastname: Alcaraz
authors.forename: Juan Carlos Pardo
authors.initials: JC
authors.lastname: Talavera
authors.forename: Pedro Jara
authors.initials: PJ
authors.lastname: Pérez
authors.forename: Antonio Esquinas
authors.initials: AE
authors.lastname: Rodriguez
authors.forename: Francisco García
authors.initials: FG
authors.lastname: Cordoba
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hill
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D003128:Coma / Q000150:complications* / Q000401:mortality; D000075202:Contraindications; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia / Q000150:complications*; D008297:Male; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome