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00925njm 22002777a 4500 dc Masa, Juan F author Utrabo, Isabel author Gomez de Terreros, Javier author Aburto, Myriam author Esteban, Cristobal author Prats, Enric author Núñez, Belén author Ortega-Gonzalez, Angel author Jara-Palomares, Luis author Jesus Martin-Vicente, M author Farrero, Eva author Binimelis Varella, Alicia author Sala, Ernest author Serrano-Rebollo, Jose C author Barrot, Emilia author Sanchez-Oro-Gomez, Raquel author Fernandez-Alvarez, Ramon author Rodriguez-Jerez, Francisco author Sayas, Javier author Benavides, Pedro author Catala, Raquel author Rivas, Francisco J author Egea Santaolalla, Carlos author Anton, Antonio author Penacoba, Patricia author Santiago-Recuerda, Ana author Gomez-Mendieta, MA author Mendez, Lidia author Cebrian, Jose J author Pina, Juan A author Zamora, Enrique author Segrelles, Gonzalo author 2016-07-07 Background: Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS. Methods: We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH >= 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure. (Continued on next page) Results: We included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 +/- 7.2 and 19 +/- 5.8 for the ACPE patients (p < 0.05), 20 +/- 5.7 and 19 +/- 5.1 for the COPD patients (p < 0.01) and 18 +/- 5.9 and 17 +/- 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 +/- 22 and 70 +/- 15 in the ACPE patients (p < 0.001), 87 +/- 21 and 76 +/- 14 in the COPD patients, and 83 +/- 17 and 74 +/- 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 +/- 3.1 vs. 3.6 +/- 2.5, NS; COPD, 5.1 +/- 3 vs. 3.6 +/- 2.1, p < 0.001; and OHS, 4.3 +/- 2.6 vs. 3.7 +/- 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups. Conclusions: ACPE, COPD and OHS patients with AHRF and severe acidosis (pH <= 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria. Masa JF, Utrabo I, Gomez De Terreros J, Aburto M, Esteban C, Prats E, et al. Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units. BMC Pulm Med. 2016 Jul 07;16:97. 10.1186/s12890-016-0262-9 1471-2466 BMC Pulmonary Medicine http://hdl.handle.net/20.500.13003/10279 27387544 L611225728 2-s2.0-84978422131 http://hdl.handle.net/20.500.12105/20273 379309700001 Noninvasive ventilation Respiratory intermediate care unit Acute hypercapnic respiratory failure COPD Acute pulmonary edema Obesity hypoventilation syndrome Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units Precision medicine in intermediate care units