title: Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease: associated factors at emergency department presentation.
abstract: OBJECTIVE
  Noninvasive ventilation (NIV) is a common practice in acute hypercapnic respiratory failure (AHRF) because of exacerbation of chronic obstructive pulmonary disease (COPD). However, a recent study has shown that patients who require invasive mechanical ventilation (IMV) after failure of NIV experience high mortality rates (up to 30%). Therefore, the aim of this study is to determine the parameters, specifically for emergency department (ED) presentation, associated with the transition from NIV to IMV because of NIV failure.
  
  
  METHODS
  This is a 4-year retrospective cohort study in the EDs of two Dutch hospitals. International Classification of Disease codes were used to identify 139 COPD patients treated with NIV. Those with AHRF (pH limits: 7.25-7.35), a full resuscitation order, and those without a pneumonia were selected for the study (n=40 with 50 NIV episodes). Parameters in patients treated successfully with NIV were compared with those in patients requiring transition to IMV due to NIV failure. Univariable regression analysis was used and, if P-value less than 0.20, analyses were entered into a multivariable logistic regression analysis model.
  
  
  RESULTS
  NIV was successful in 33 (66%) patients, 10 (20%) required transition to IMV, and seven (14%) died. Age over 65 years and a Glasgow Coma Score less than 15 were associated significantly with the transition from NIV to IMV in multivariable analysis (P<0.05).
  
  
  CONCLUSIONS
  Older age and a low Glasgow Coma Score at ED presentation are factors associated with the transition from NIV to IMV in COPD patients with AHRF.
authors.affiliation: aDepartment of Internal Medicine, Academic Medical Center, Amsterdam bDepartment of Pulmonology, Diakonessenhuis, Utrecht Departments of cEmergency Medicine dSurgery, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Johanna P
authors.initials: JP
authors.lastname: van Gemert
authors.forename: Folkert
authors.initials: F
authors.lastname: Brijker
authors.forename: Marja A
authors.initials: MA
authors.lastname: Witten
authors.forename: Loek P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D012121:Respiration, Artificial / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017211:Treatment Failure