title: Noninvasive ventilation using a mouthpiece in patients with chronic obstructive pulmonary disease and acute respiratory failure.
abstract: BACKGROUND
  Noninvasive positive pressure ventilation (NPPV) delivered via a mouthpiece (mNPPV) has been successfully used in stable chronic restrictive respiratory insufficiency, but not in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF).
  
  
  OBJECTIVE
  The purpose of this matched case-control study was to compare the usefulness of mNPPV to noninvasive ventilation using a nasal or oronasal mask (nNPPV) or standard medical treatment (SMT) in COPD patients with ARF.
  
  
  METHODS
  Twenty-nine patients receiving mNPPV were matched with 29 patients receiving nNPPV and 29 patients receiving SMT regarding age, SAPSII, admission PaCO(2) and pH.
  
  
  RESULTS
  In the mNPPV group, admission PaCO(2) and pH were 78.6 +/- 12 mm Hg and 7.30 +/- 0.04, respectively. mNPPV and nNPPV avoided the need for endotracheal intubation in 27 and 25 patients, respectively (nonsignificant) whereas SMT resulted in a higher mechanical ventilation rate (13 patients). At the end of the treatment protocol, PaCO(2) was lower in the mNPPV group (62.2 +/- 9.6 mm Hg) than in the SMT group (72.4 +/- 20.4 mm Hg, p < 0.018) leading to a significantly higher pH. No significant differences were observed between the mNPPV and nNPPV groups.
  
  
  CONCLUSIONS
  In case of moderate respiratory acidosis, noninvasive ventilation using a mouthpiece significantly reduces the endotracheal intubation rate in comparison with SMT and therefore appears to be a second-line alternative to noninvasive ventilation delivered via a mask, especially when poorly tolerated.
authors.affiliation: Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier Universitaire SUD, Amiens, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Glerant
authors.forename: D
authors.initials: D
authors.lastname: Rose
authors.forename: V
authors.initials: V
authors.lastname: Oltean
authors.forename: C
authors.initials: C
authors.lastname: Dayen
authors.forename: I
authors.initials: I
authors.lastname: Mayeux
authors.forename: V
authors.initials: V
authors.lastname: Jounieaux
mesh_terms: D000208:Acute Disease; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D017214:Laryngeal Masks; D008297:Male; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome