Chest
Clinical Investigations in Critical CareNoninvasive Positive Pressure Ventilation in Patients With Acute Exacerbations of COPD and Varying Levels of Consciousness
Section snippets
Materials and Methods
This was an observational matched case-control study with prospectively collected data that was performed in patients who received NPPV for treatment of ARF due to COPD exacerbation, in our Respiratory Monitoring Unit,17 which is located within the Respiratory Ward of Arezzo “S. Donato” Hospital, between January 1998 and January 2003. The study protocol was approved by the local ethics committee of our hospital, and the study was performed in accordance with the ethical standards laid down in
Results
During the study period, 685 patients with acute decompensation of COPD were admitted to our unit; most of them improved quickly with medical therapy (485 of 685 patients; 70.8%). Among the remaining 200 eligible patients with ARF, 32 (16%) were excluded from the study because of the need for urgent ETI, and 15 (7.5%) were excluded because of their refusal of NPPV. The remaining 153 patients received NPPV a median time of 9.0 h (IQR, 1.50 to 69.75 h) after admission into our unit; 60 of them
Discussion
This is the first case-control study performed in patients experiencing acute exacerbations of COPD that was aimed at evaluating the efficacy of NPPV in patients with increasing degrees of ALC compared to fully alert subjects. The application of NPPV was able to quickly improve gas exchange and neurologic status in the large majority of patients, irrespective of the severity of the ALC. However, while in patients with mild-to-moderate ALC (Kelly score, ≤ 3) NPPV was highly successful in terms
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