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Respir Care. 2014 Dec;59(12):1825-31. doi: 10.4187/respcare.03009. Epub 2014 Aug 19.

Open-mouthpiece ventilation versus nasal mask ventilation in subjects with COPD exacerbation and mild to moderate acidosis: a randomized trial.

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Respiratory Medicine Unit, Hospital of Sestri Levante, Italy
Internal Medicine Department, Hospital of Lavagna, Liguria, Italy.
Hygiene and Public Health Department, Azienda Unità Sanitaria 4 Chiavarese, Liguria, Italy.
Forensic Medicine, Azienda Unità Sanitaria 4 Chiavarese, Liguria, Italy.



Open mouthpiece ventilation is efficacious in patients with neuromuscular disease. We used this ventilation technique in patients with exacerbations of COPD with mild to moderate acidosis.


The study was performed in 2 respiratory monitoring care units. Fifty subjects with exacerbations of COPD, breathing frequency > 25, PaCO2 > 45, and pH between 7.25 and 7.30, as well as Kelly scale ≤ 2 were enrolled. Subjects were randomly assigned to receive noninvasive ventilation (NIV) via nasal mask or mouthpiece ventilation. The primary outcome was improvement in arterial blood gases. Arterial blood gases and breathing frequency were recorded 2 h after the start of the enrollment and then after 12, 24, and 48 h. The duration of NIV, hospital stay, and acceptability of the interface (mouthpiece or nasal mask) using a Likert scale were assessed.


No subjects had deterioration of gas exchange. The 2 groups had similar trends in arterial blood gases and breathing frequency. No differences in duration of NIV or hospital stay were noted. However, a significant difference in acceptability was found: subjects preferred mouthpiece ventilation (P < .01).


Open mouthpiece ventilation is a useful technique and may prevent further deterioration of gas exchange in COPD patients with mild to moderate acidosis (similar to traditional NIV delivered by a nasal mask). registration ChiCTR-TRC-12002672.


Likert scale; chronic obstructive pulmonary disease; hypercapnic respiratory failure; nasal mask; open mouthpiece ventilation

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