title: Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study.
abstract: OBJECTIVE
  To date non-invasive (NIV) mechanical ventilation use is not recommended in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) and pH < 7.30 outside a 'protected environment'. We assessed NIV efficacy and feasibility in improving arterial blood gases (ABG) and in-hospital outcome in patients with ARF and severe respiratory acidosis (RA) admitted to an experienced rural medical ward.
  
  
  METHODS
  This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio's District Hospital. Two hundred and seventy-two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria (pH < 7.35, PaCO2 > 45 mmHg). Patients were divided according to the severity of acidosis into: group A (pH < 7.26), group B (7.26 ≤ pH < 7.30) and group C (7.30 ≤ pH < 7.35). ABG were assessed at admission, at 2-6 h, 24 h, 48 h and at discharge.
  
  
  RESULTS
  Group A included 55 patients (24 men, mean age: 80.8 ± 8.3 years), group B 31 (12 men, mean age: 80.3 ± 9.4 years) and group C 26 (15 men, mean age: 78.6 ± 9.9 years). ABG improved within the first hours in 92/112 (82%) patients, who were all successfully discharged. Eighteen percent (20/112) of the patients died during the hospital stay, no significant difference emerged in mortality rate (MR) within the groups (23%, 16% and 8%, for groups A, B and C, respectively) and between patients with or without pneumonia: 8/29 (27%) versus 12/83 (14%). On multivariable analysis, only age and Glasgow Coma Scale had an impact on the clinical outcome.
  
  
  CONCLUSIONS
  In a non-'highly protected' environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: S
authors: S
authors: Fiorino
authors: Istituto di Cardiologia, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Department of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy.
authors: L
authors: L
authors: Bacchi-Reggiani
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: E
authors: E
authors: Detotto
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: M
authors: M
authors: Battilana
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: E
authors: E
authors: Borghi
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: C
authors: C
authors: Denitto
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: C
authors: C
authors: Dickmans
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: B
authors: B
authors: Facchini
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: R
authors: R
authors: Moretti
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: S
authors: S
authors: Parini
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: M
authors: M
authors: Testi
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: A
authors: A
authors: Zamboni
authors: Unità Operativa di Medicina Interna, Ospedale di Budrio (Bologna), Department of Internal Medicine, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy.
authors: A
authors: A
authors: Cuppini
authors: Terapia Intensiva Pneumologia S. Orsola, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Department of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy.
authors: L
authors: L
authors: Pisani
authors: Terapia Intensiva Pneumologia S. Orsola, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Department of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy.
authors: S
authors: S
authors: Nava
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006935:Hypercapnia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D008297:Male; D010865:Pilot Projects; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: acute respiratory failure; chronic obstructive pulmonary disease; non-invasive mechanical ventilation