title: Open-mouthpiece ventilation versus nasal mask ventilation in subjects with COPD exacerbation and mild to moderate acidosis: a randomized trial.
abstract: BACKGROUND
  Open mouthpiece ventilation is efficacious in patients with neuromuscular disease. We used this ventilation technique in patients with exacerbations of COPD with mild to moderate acidosis.
  
  
  METHODS
  The study was performed in 2 respiratory monitoring care units. Fifty subjects with exacerbations of COPD, breathing frequency > 25, PaCO2 > 45, and pH between 7.25 and 7.30, as well as Kelly scale ≤ 2 were enrolled. Subjects were randomly assigned to receive noninvasive ventilation (NIV) via nasal mask or mouthpiece ventilation. The primary outcome was improvement in arterial blood gases. Arterial blood gases and breathing frequency were recorded 2 h after the start of the enrollment and then after 12, 24, and 48 h. The duration of NIV, hospital stay, and acceptability of the interface (mouthpiece or nasal mask) using a Likert scale were assessed.
  
  
  RESULTS
  No subjects had deterioration of gas exchange. The 2 groups had similar trends in arterial blood gases and breathing frequency. No differences in duration of NIV or hospital stay were noted. However, a significant difference in acceptability was found: subjects preferred mouthpiece ventilation (P < .01).
  
  
  CONCLUSIONS
  Open mouthpiece ventilation is a useful technique and may prevent further deterioration of gas exchange in COPD patients with mild to moderate acidosis (similar to traditional NIV delivered by a nasal mask). www.chictr.org registration ChiCTR-TRC-12002672.
authors.affiliation: Respiratory Medicine Unit, Hospital of Sestri Levante, Italy antonello.nicolini@fastwebnet.it.
authors.forename: Antonello
authors.initials: A
authors.lastname: Nicolini
authors.affiliation: Internal Medicine Department, Hospital of Lavagna, Liguria, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santo
authors.affiliation: Hygiene and Public Health Department, Azienda Unità Sanitaria 4 Chiavarese, Liguria, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Ferrari-Bravo
authors.affiliation: Forensic Medicine, Azienda Unità Sanitaria 4 Chiavarese, Liguria, Italy.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Barlascini
mesh_terms: D000142:Acidosis, Respiratory / Q000097:blood* / Q000209:etiology; D000368:Aged; D001784:Blood Gas Analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008397:Masks; D063087:Noninvasive Ventilation / Q000295:instrumentation*; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D056152:Respiratory Rate; D013997:Time Factors
keywords: Likert scale; chronic obstructive pulmonary disease; hypercapnic respiratory failure; nasal mask; open mouthpiece ventilation