TY - JOUR T1 - Treating Failure of Noninvasive Ventilation for Acute Respiratory Failure Due to COPD: Sooner the Better JF - Respiratory Care SP - 1642 LP - 1643 DO - 10.4187/respcare.10679 VL - 67 IS - 12 AU - Anjan Devaraj AU - Anas Ahmed AU - Nicholas S Hill Y1 - 2022/12/01 UR - http://rc.rcjournal.com/content/67/12/1642.abstract N2 - Over the past 2 decades, use of noninvasive ventilation (NIV) has increased dramatically for both hypoxemic and hypercapnic forms of respiratory failure as well as the two combined. The American Thoracic Society/European Respiratory Society practice guidelines1 strongly recommend the use of NIV for acute and acute on chronic respiratory failure due to COPD exacerbations. This recommendation stems from robust data including physiologic studies demonstrating reductions in breathing frequency,2 dyspnea and work of breathing,3 as well as randomized controlled trials and systematic analyses from over the past 30 years showing reductions in the rate of intubation and mortality.4 The success rate of NIV in avoiding intubation and/or death for patients with acute respiratory failure due to COPD exacerbations is very high, from 80–90% in most studies.5 However, for the 10–20% who fail, caution is advised to avoid delay of a needed intubation, which is associated with increased mortality.6 Although the role of NIV for respiratory failure due to COPD exacerbations has been firmly established, the timing of escalation to intubation in such patients who are failing NIV has not.As a result, the question of which patients will fail NIV and require early intubation continues to elude researchers. An earlier study had suggested that it was possible to quickly delineate between subjects who fail NIV and those who succeed, as there was a significant difference in the response of subjects’ pH and serum carbon dioxide levels within the first few hours of NIV.5 However, the … Correspondence: Nicholas S Hill MD, Pulmonary and Critical Care Division, Tufts Medical Center, 800 Washington Street, Boston, MA 02111. E-mail: nhill{at}tuftsmedicalcenter.org ER -