Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure.

Noninvasive ventilation (NIV) has changed the prognosis of patients with chronic obstructive pulmonary disease (COPD) suffering from hypercapnic exacerbations. The aim of the study was to evaluate the mortality rate and need for intubation of patients with during hypercapnic COPD exacerbation treated with NIV and to estimate factors related to either success or failure of NIV in a real-life setting. In a multicenter prospective study conducted over a period of 10 years (2002-2012), we assessed 1809 patients with COPD with hypercapnic exacerbation on admission who were treated with NIV. The primary outcomes were the intubation rate and hospital mortality. In all patients, NIV was conducted by experienced specialists. The intubation rate was 6.6% and the mortality rate was 5.3%. The severity of exacerbations, defined by pH and the Simplified Acute Physiology Score (SAPS II) on admission, worsened during the study period. The presence of comorbidities, SAPS II, pH, the ratio of oxygen arterial pressure to oxygen inspiratory fraction on admission, and, above all, no increase in pH after 1 hour of NIV were closely related to hospital mortality. Team expertise in NIV and identification of the risk factors for NIV failure may allow to treat patients with more severe hypercapnic exacerbations of COPD during and improve treatment success rates.