Damla SERÇE UNAT, Nilay ERTEN TURAN, Ömer Selim UNAT, Mutlu Onur GÜÇSAV, Emine Sena DİKMENTEPE, Hakan KAHRAMAN, Aydan MERTOĞLU
Forbes Tıp Dergisi - 2026;7(1):90-97
Objective: Early identification of non-invasive ventilation (NIV) failure in patients with acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD) exacerbation remains a critical clinical challenge, particularly in emergency departments. This study aimed to evaluate whether early arterial blood gas changes after NIV initiation predict intensive care unit (ICU) admission and in-hospital intubation and to develop a simple predictive model based on early physiological response. Methods: This multicenter retrospective study included 319 patients with COPD exacerbation complicated by acute hypercapnic respiratory failure who were initiated on NIV in the emergency departments of three hospitals. Arterial blood gas parameters were recorded before NIV initiation and 1-3 hours thereafter. Early response was defined as the change in PaCO2 (DeltaPaCO2). Multivariable logistic regression models were constructed for ICU admission and intubation. Model discrimination was assessed using receiver operating characteristic curve analysis. Results: During hospitalization, 138 patients (43.3%) required ICU admission, and 70 patients (21.9%) required intubation. Lower post-NIV pH, insufficient reduction in DeltaPaCO2, and prior ICU admission independently predicted the need for ICU care and intubation. The model demonstrated good discriminative performance for ICU admission [area under the curve (AUC) =0.787; 95% confidence interval (CI): 0.737-0.837] and for intubation (AUC =0.810; 95% CI: 0.746-0.873). Conclusion: Early physiological response to NIV, particularly post-treatment pH and the magnitude of PaCO2 reduction, provides clinically meaningful prognostic information and may assist early decision-making in emergency settings. External validation is warranted.
