TY - JOUR T1 - Predicting the outcome from NIV for acute exacerbations of COPD JF - Thorax JO - Thorax SP - 815 LP - 816 DO - 10.1136/thorax.55.10.815 VL - 55 IS - 10 AU - J V J LIGHTOWLER AU - M W ELLIOTT Y1 - 2000/10/01 UR - http://thorax.bmj.com/content/55/10/815.abstract N2 - The use of non-invasive ventilation (NIV) in the management of acute exacerbations of chronic obstructive pulmonary disease (COPD) is now supported by a number of randomised controlled trials.1-5 It has been shown to reduce intubation rates,1 ,3-5 mortality,1 ,2-5 and length of stay.1 ,4 It has the advantage that it can be applied intermittently, avoids the need for sedation, and allows the patient to eat, drink and talk. The incidence of nosocomial pneumonia during NIV is lower than in intubated patients.6-8 NIV has the additional advantage that it can be used with success outside the intensive care unit (ICU), thereby reducing the demand on ICU beds.5 However, NIV is not without its problems. The mask can be uncomfortable and claustrophobic for an acutely dyspnoeic patient, it can cause facial skin necrosis and, if poorly fitted, may be associated with large amounts of leakage which may compromise the efficiency of ventilation. Gastric distension is also recognised. Without the presence of an endotracheal/tracheostomy tube the lower airway cannot be easily accessed which makes bronchial toilet difficult. NIV is not successful in all cases of acute on chronic respiratory failure due to COPD, with reported failure rates of 7–50%.4 ,9 There has also been concern that NIV may delay intubation leading to a worse outcome.10 ,11 The ability to predict those likely to fail with NIV is important. Patients in whom there is a high likelihood of failure would be spared the discomfort of a trial of NIV and intubation would not be delayed. It would also be helpful in determining where NIV should take place; a patient with a high likelihood of failing, and for whom intubation would be considered appropriate, is best managed in the ICU, whereas the … ER -