TY - JOUR T1 - Discontinuing noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations: a randomised controlled trial JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01448-2016 VL - 50 IS - 1 SP - 1601448 AU - Jacobo Sellares AU - Miquel Ferrer AU - Antonio Anton AU - Hugo Loureiro AU - Carolina Bencosme AU - Rodrigo Alonso AU - Pilar Martinez-Olondris AU - Javier Sayas AU - Patricia Peñacoba AU - Antoni Torres Y1 - 2017/07/01 UR - http://erj.ersjournals.com/content/50/1/1601448.abstract N2 - We assessed whether prolongation of nocturnal noninvasive ventilation (NIV) after recovery from acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) patients with NIV could prevent subsequent relapse of AHRF.A randomised controlled trial was performed in 120 COPD patients without previous domiciliary ventilation, admitted for AHRF and treated with NIV. When the episode was resolved and patients tolerated unassisted breathing for 4 h, they were randomly allocated to receive three additional nights of NIV (n=61) or direct NIV discontinuation (n=59). The primary outcome was relapse of AHRF within 8 days after NIV discontinuation.Except for a shorter median (interquartile range) intermediate respiratory care unit (IRCU) stay in the direct discontinuation group (4 (2–6) versus 5 (4–7) days, p=0.036), no differences were observed in relapse of AHRF after NIV discontinuation (10 (17%) versus 8 (13%) for the direct discontinuation and nocturnal NIV groups, respectively, p=0.56), long-term ventilator dependence, hospital stay, and 6-month hospital readmission or survival.Prolongation of nocturnal NIV after recovery from an AHRF episode does not prevent subsequent relapse of AHRF in COPD patients without previous domiciliary ventilation, and results in longer IRCU stay. Consequently, NIV can be directly discontinued when the episode is resolved and patients tolerate unassisted breathing.NIV can be directly discontinued when a COPD exacerbation is resolved and patients tolerate unassisted breathing http://ow.ly/fJCY30bYfme ER -