title: Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?
abstract: OBJECTIVE
  Noninvasive mechanical ventilation (NIMV) usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF). We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward.
  
  
  METHODS
  This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20-7.25) and group 2 (pH=7.26-7.30).
  
  
  RESULTS
  Group 1 included 59 patients (mean age: 70±10 years, 30.5% female) and group 2 included 171 patients (mean age: 67±11 years, 28.7% female). On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2) ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward.
  
  
  CONCLUSIONS
  NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success.
authors.affiliation: Department of Pulmonary Medicine, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Yalcinsoy
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Salturk
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Selahattin
authors.initials: S
authors.lastname: Oztas
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sinem
authors.initials: S
authors.lastname: Gungor
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ipek
authors.initials: I
authors.lastname: Ozmen
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Feyyaz
authors.initials: F
authors.lastname: Kabadayi
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Aysem Askim
authors.initials: AA
authors.lastname: Oztim
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Aksoy
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Nalan
authors.initials: N
authors.lastname: Adıguzel
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Oruc
authors.affiliation: Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Karakurt
mesh_terms: D000138:Acidosis / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D017211:Treatment Failure
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D010100:Oxygen
keywords: COPD; acute respiratory failure; exacerbation; mortality; noninvasive mechanical ventilation