title: A controlled trial of noninvasive ventilation for chronic obstructive pulmonary disease exacerbations.
abstract: OBJECTIVE
  This prospective, multicenter, double-blind, placebo-controlled study tested the hypothesis that noninvasive positive pressure ventilation reduces the need for endotracheal intubation in patients hospitalized in a pulmonary ward because of acute exacerbation of chronic obstructive pulmonary disease.
  
  
  METHODS
  Seventy-five consecutive patients with exacerbation (pH, 7.31 +/- 0.02; Pao(2), 45 +/- 9 mm Hg; Paco(2), 69 +/- 13 mm Hg) were randomly assigned to receive noninvasive ventilation or sham noninvasive ventilation during the first 3 days of hospitalization on top of standard medical treatment.
  
  
  RESULTS
  The need for intubation (according to predefined criteria) was lower in the noninvasive ventilation group (13.5% vs 34%, P < .01); in 31 patients with pH not exceeding 7.30, these percentages were 22% and 77%, respectively (P < .001). Arterial pH and Paco(2) improved in both groups, but changes were enhanced by noninvasive ventilation. Length of stay was lower in the noninvasive ventilation group (10 +/- 5 vs 12 +/- 6 days, P = .06). In-hospital mortality was similar in both groups.
  
  
  CONCLUSIONS
  These results demonstrate that noninvasive positive pressure ventilation, in a pulmonary ward, reduces the need for endotracheal intubation, particularly in the more severe patients, and leads to a faster recovery in patients with acute exacerbation of chronic obstructive pulmonary disease.
authors.affiliation: Servicio de Neumología of Hospital Universitario Son Dureta, 07014 Palma de Mallorca, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Carrera
authors.forename: José M
authors.initials: JM
authors.lastname: Marín
authors.forename: Antonio
authors.initials: A
authors.lastname: Antón
authors.forename: Eusebi
authors.initials: E
authors.lastname: Chiner
authors.forename: Maria L
authors.initials: ML
authors.lastname: Alonso
authors.forename: Juan F
authors.initials: JF
authors.lastname: Masa
authors.forename: Ramón
authors.initials: R
authors.lastname: Marrades
authors.forename: Ernest
authors.initials: E
authors.lastname: Sala
authors.forename: Santiago
authors.initials: S
authors.lastname: Carrizo
authors.forename: Jordi
authors.initials: J
authors.lastname: Giner
authors.forename: Elia
authors.initials: E
authors.lastname: Gomez-Merino
authors.forename: Joaquin
authors.initials: J
authors.lastname: Teran
authors.forename: Carlos
authors.initials: C
authors.lastname: Disdier
authors.forename: Alvar G N
authors.initials: AG
authors.lastname: Agustí
authors.forename: Ferran
authors.initials: F
authors.lastname: Barbé