Effectiveness of noninvasive ventilation in very severe exacerbation of chronic obstructive pulmonary disease

BACKGROUND: The aim of this study was to demonstrate that noninvasive ventilation can be safely employed in very severe exacerbation of chronic obstructive pulmonary disease (COPD). METHODS: A retrospective study (January 2006 - December 2012) was conducted among 109 hospitalized patients with severe COPD admitted to the medical-surgical intensive care unit, who underwent noninvasive ventilation. Demographic variables, Simplified Acute Physiology Score 3, organ dysfunction using sequential organ failure assessment, comorbidities, hemodynamic, respiratory, and gasometric parameters were collected at admission. The cause of noninvasive ventilation failure, intubation rate, needs to reintubation or perform a tracheotomy, infectious complications, acute renal failure rate, acute respiratory distress syndrome rate, duration of ventilation, length of stay, and mortality were collected. The predicting factors of noninvasive ventilation failure and mortality were determined. RESULTS: Noninvasive ventilation failure rate was 17 (15%) cases, of which 10 (58%) patients were intubated. Noninvasive ventilation failure group presented a greater incidence of reintubation, a need for a tracheotomy, and ventilation-associated pneumonia. The rates for intensive care unit mortality (1% vs. 41% failure group, P<0.0001), hospital mortality (5% vs. 53% failure group, P<0.001), and six-month mortality (11% vs. 53% failure group, P<0.0001) were clearly higher in the failure group. The multivariate analysis showed that noninvasive ventilation failure was related to tachycardia at admission, with an area under the Receiver Operating Characteristic curve of 0.72 (95% CI 1.007-1.065, P=0.08). Noninvasive ventilation failure was a determining factor of mortality [Relative Risk 46.530 (95% CI 5.713-378.945, P=0.0001)]. CONCLUSIONS: Noninvasive ventilation is effective in patients with very severe COPD.