{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T09:08:10Z","timestamp":1771060090452,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Respiratory J"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Noninvasive ventilation (NIV) is the treatment of choice in cases of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, depressed mental status, frequently caused by AECOPD, represents a relative contraindication to NIV. This study evaluates the efficacy of NIV in patients with AECOPD with moderate to severe impairment of consciousness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this monocentric, retrospective study, we included patients admitted to the emergency department (ED) from January 2018 to December 2022 for AECOPD, altered mental status (GCS\u2009\u2264\u200913 and\/or KMS\u2009\u2265\u20092) and treated with NIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 919 patients admitted with acute respiratory failure, 228 (24.8%) met the inclusion criteria for AECOPD. Of these, 205 (90%) underwent NIV during the ED admissions without adverse events. In 48 patients (21.1%), NIV was withdrawn due to clinical improvement. Only 23 (10.1%) experienced NIV failure with worsening of hypoxemia and occurrence of hypotension, of whom 16 (7% of the total population) died in the ED. Severe neurological impairment (low GCS) was an independent predictor of mortality. Systolic and diastolic blood pressure, SpO\n                      <jats:sub>2<\/jats:sub>\n                      , pH value and lactate levels were predictive of early mortality. COVID\u201019 status did not significantly affect mortality rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      NIV was feasible and associated with successful outcomes in a majority of patients with AECOPD and moderate to severe neurological impairment. Specific parameters, including initial GCS, blood pressure, SpO\n                      <jats:sub>2<\/jats:sub>\n                      , and blood gas profiles, can help predict outcomes and treatment efficacy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/crj.70166","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:19:21Z","timestamp":1769599161000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Efficacy of Noninvasive Ventilation in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Decreased Level of Consciousness: A Retrospective Study"],"prefix":"10.1111","volume":"20","author":[{"given":"Irma\u00a0Sofia","family":"Fabbri","sequence":"first","affiliation":[{"name":"Department of Translational Medicine University of Ferrara  Ferrara Italy"},{"name":"School of Emergency Medicine University of Ferrara  Ferrara Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Pagano","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine University of Ferrara  Ferrara Italy"},{"name":"School of Emergency Medicine University of Ferrara  Ferrara Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuri","family":"Darin","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine University of Ferrara  Ferrara Italy"},{"name":"School of Emergency Medicine University of Ferrara  Ferrara Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Portoraro","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine University of Ferrara  Ferrara Italy"},{"name":"School of Emergency Medicine University of Ferrara  Ferrara 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