Early noninvasive ventilation failure in COPD with acute on chronic respiratory failure.

The patient was a 72-yr-old male with chronic respiratory failure from COPD, successfully treated with nocturnal bilevel pressure NIV for 20 months. He was hospitalised in our respiratory intensive care unit (CHU de Rouen, Hôpital de Bois-Guillaume, Rouen, France) for ARF (pH57.26; arterial carbon dioxide tension (Pa,CO2) 11.4 kPa; arterial oxygen tension (Pa,O2)/ inspiratory oxygen fraction (FI,O2) 338). The patient presented with bilateral wheezing, encephalopathy and gaseous abdominal distension. Standard medical treatment associated with NIV failed to improve the patient’s condition, despite different settings with pressure-preset and flow-preset ventilatory modes, and careful management with facial and nasal masks. Five hours after admission, the patient’s condition worsened (pH57.12; Pa,CO2 19.2 kPa; Pa,O2/FI,O2 115). Intubation was then performed, subsequently revealing a laryngeal vestibule carcinoma, partially obstructing the glottis aperture. After tumoural laser resection, the patient was successfully weaned, extubated and then discharged home with his previous NIV treatment.