Noninvasive mechanical ventilation in the weaning of AECOPD patients with respiratory failure : modified glasgow coma scale score ≥ 13 as the switching point

Background: Sequential noninvasive ventilation improves the outcomes of weaning from invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure. However, the optimal timing is still controversial. Herein, the efficacy and feasibility of using a modified Glasgow Coma Scale (GCS) score ≥13 points was investigated as the switching point. Methods: All 152 AECOPD patients who received invasive mechanical ventilation (IMV) between May 2015 and June 2017 in the intensive care units at 3 institutions were randomly assigned to a sequential noninvasive ventilation (NIV) or a control group (n = 76 for both groups). Modified GCS score ≥13 points and clinically stable condition for 3 hours was used as the criteria for initiation of weaning. Results: In the NIV group, there were no significant differences with respect to mean blood pressure, oxygenation index, respiratory rate, pH, arterial partial pressure of carbon dioxide and oxygen between the two time-points: before extubation and 3 hours after extubation. Compared with the control group, sequential NIV significantly decreased hospital mortality from 22.37% to 6.58% (p = 0.06), reduced the duration of IMV, and shortened the length of hospital stay. Conclusions: The application of a modified GCS score ≥13 as the switching point for sequential invasive-noninvasive ventilation may significantly improve prognosis of AECOPD patients with respiratory failure.