• Fionnuala Crummy, Catherine Buchan, Belinda Miller, Jo Toghill, and Matthew T Naughton.
• Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Prahran, Victoria, Melbourne, Victoria, Australia.
• Respir Med. 2007 Jan 1;101(1):53-61.

Study ObjectivesTo compare the effect of noninvasive mechanical ventilation (NIV) in severely acidotic with mildly acidotic patients with acute hypercapnic chronic obstructive lung disease (COPD).DesignComparison of NIV in consecutively enrolled patients with acute hypercapnic COPD with mild (pH 7.25-7.35) or severe (pH<7.25) acidosis on time to normalise pH and improve PaCO(2), duration of NIV treatment, length of stay in hospital and survival. Results (meadian (IQR)): Twenty-nine patients had 36 episodes of acute hypercapnic respiratory failure: Seventeen with pH<7.25 and 19 with pH 7.25-7.34. Compared with the mildly acidotic group, the severely acidotic group took a similar length of time for pH to normalise and PaCO(2) improve (12 (6-34) vs 12 (4-28)h, respectively, P=0.42), with similar duration of NIV treatment (60 (35-96) vs 68 (36-48)h, respectively, P=0.25) and hospital length of stay (8 (7-18) vs 9 (5-17) days, respectively, P=0.61). Overall survival was 89%, with 95% in the mild and 82% in the severely acidotic groups.ConclusionsNoninvasive ventilation is effective in the treatment of patients with severe acidosis due to acute hypercapnic COPD.

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