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N No on ni in nv va as si iv ve e m me ec ch ha an ni ic ca al l v ve en nt ti il la at ti io on n i im mp pr ro ov ve es s t th he e i im mm me ed di ia at te e a an nd dl lo on ng g--t te er rm m o ou ut tc co om me e o of f C CO OP PD D p pa at ti ie en nt ts s w wi it th h a ac cu ut te e r re es sp pi ir ra at to or ry y f fa ai il lu ur re e M. Confalonieri*, P. Parigi*, A. Scartabellati*, S. Aiolfi*, S. Scorsetti*, S Nava**, L. Gandola* In-hospital survival rate was not significantly different in Group A vs Group B, but the patients treated with NPPV showed an earlier improvement in blood gases and a better pH and respiratory rate at discharge. Only 2 patients of Group A needed endotracheal intubation as compared with 9 of Group B. Hospital stay was significantly reduced in survivors of Group A vs Group B. Further severe relapses of ACRF in Group A were treated using NPPV. The number and length of further hospitalizations for pulmonary exacerbations were significantly higher in Group B compared with Group A. The survival rate at 12 months was significantly lower in Group B than in Group A (50% vs 71%).In conclusion, NPPV administration in patients with ACRF due to exacerbated COPD improves not only immediate but also long-term outcome.

Bi-level pressure support ventilation via a nasal mask (NIPSV) was provided to 28 consecutive unselected patients with acute respiratory failure due to exacerbation of chronic obstructive pulmonary failure (COPD). If NIPSV improved gas exchange within 2 h, it was continued. Otherwise, patients would be promptly intubated. The patients median age was 68 years (minimum 56, maximum 82). The arterial blood gas drawn before initiating NIPSV showed (FiO₂ 21%) a mean PaO₂ of 41.3 ± 6 mm Hg, a mean PaCO₂ of 66 ± 15 mm Hg and a mean pH of 7.31. Upon admission the mean respiratory rate was 36 breaths/min and the median Apache II score was 20.5 (minimum 13, maximum 32). Despite oxygen administration all patients failed to improve their PaO₂ and/or showed a consistent and dangerous hypercapnic response. NIPSV was performed with a median inspiratory positive airway pressure of 14 cm H₂O (minimum 10, maximum 20) and a median expiratory positive airway pressure of 4 cm H₂O (minimum 3, maximum 6). Eighteen patients (64%) were successfully ventilated with NIPSV, while in 10 (36%) NIPSV failed. A high Apache II score, but not admission blood gas exchange or respiratory rate, seems to be correlated with the failure to ventilate with NIPSV. The results of our preliminary experience suggest the use of NIPSV as an initial approach to acute respiratory failure due to exacerbation of COPD, particularly in patients with an Apache II score of less than 29.