Q: All of the following predicts probable failure of non-invasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of  COPD except?

A) Glasgow Coma Score less than 8
B) APACHE II score more than or equal to 29
C) Respiratory rate more than or equal to 30 
D) PH less than 7.25
E) No improvement in ABG after 2 hours on NIPPV


Answer: A

Glasgow Coma Score less than 11 predicts probable failure of trial of standard two hours of NIPPV in patients with acute exacerbation of COPD. All other choices are applicable too. Also, if patient PH does not show any improvement or remain less than 7.25 after 2 hours trial of NIPPV, predicts probable intubation.


References: 

1. Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J 2005; 25:348. 

2. Stefan MS, Shieh MS, Pekow PS, et al. Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011. Chest 2015; 147:959. 

3. Phua J, Kong K, Lee KH, et al. Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure. Intensive Care Med 2005; 31:533. 

4. Carratù P, Bonfitto P, Dragonieri S, et al. Early and late failure of noninvasive ventilation in chronic obstructive pulmonary disease with acute exacerbation. Eur J Clin Invest 2005; 35:404.