• Miguel Carrera, José M Marín, Antonio Antón, Eusebi Chiner, Maria L Alonso, Juan F Masa, Ramón Marrades, Ernest Sala, Santiago Carrizo, Jordi Giner, Elia Gomez-Merino, Joaquin Teran, Carlos Disdier, Alvar G N Agustí, and Ferran Barbé.
• Servicio de Neumología of Hospital Universitario Son Dureta, 07014 Palma de Mallorca, Spain.
• J Crit Care. 2009 Sep 1;24(3):473.e7-14.

PurposeThis prospective, multicenter, double-blind, placebo-controlled study tested the hypothesis that noninvasive positive pressure ventilation reduces the need for endotracheal intubation in patients hospitalized in a pulmonary ward because of acute exacerbation of chronic obstructive pulmonary disease.Materials And MethodsSeventy-five consecutive patients with exacerbation (pH, 7.31 +/- 0.02; Pao(2), 45 +/- 9 mm Hg; Paco(2), 69 +/- 13 mm Hg) were randomly assigned to receive noninvasive ventilation or sham noninvasive ventilation during the first 3 days of hospitalization on top of standard medical treatment.ResultsThe need for intubation (according to predefined criteria) was lower in the noninvasive ventilation group (13.5% vs 34%, P < .01); in 31 patients with pH not exceeding 7.30, these percentages were 22% and 77%, respectively (P < .001). Arterial pH and Paco(2) improved in both groups, but changes were enhanced by noninvasive ventilation. Length of stay was lower in the noninvasive ventilation group (10 +/- 5 vs 12 +/- 6 days, P = .06). In-hospital mortality was similar in both groups.ConclusionsThese results demonstrate that noninvasive positive pressure ventilation, in a pulmonary ward, reduces the need for endotracheal intubation, particularly in the more severe patients, and leads to a faster recovery in patients with acute exacerbation of chronic obstructive pulmonary disease.

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