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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-invasive mechanical ventilation &#40;NIV&#41; is a common treatment option&#44; but its use in patients with severe acute pneumonia &#40;SAP&#41; admitted to an intensive care unit &#40;ICU&#41; is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Rapid detection of any signs of failure is essential after applying appropriate first-line NIV in carefully selected patients&#44; since delay in performing endotracheal intubation &#40;ETI&#41; is a factor for increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We read with great interest the study of Rialp et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> on the use of NIV in patients with SAP but without chronic obstructive pulmonary disease &#40;COPD&#41;&#46; However&#44; we believe that some key aspects need to be clarified&#44; due to the practical implications associated with the interpretation and potential application of their findings in routine practice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Firstly&#44; the interpretation of PaCO<span class="elsevierStyleInf">2</span> values in non-COPD patients is controversial&#46; The authors report that PaCO<span class="elsevierStyleInf">2</span> was higher in patients treated with first-line NIV than in those who received first-line invasive mechanical ventilation &#40;MV&#41;&#46; This bias is unclear&#44; and in our opinion&#44; it is difficult to conclude that none of the study patients included in this study had COPD purely on the basis of symptoms of dyspnea&#44; chronic cough&#44; and expectoration&#44; since spirometric data are essential to establish a diagnosis of COPD&#46; We believe then that other factors must be taken into account that might possibly explain the hypercapnia values in both groups&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Useful key points to consider may be that these higher PaCO<span class="elsevierStyleInf">2</span> values were due to variations in the time of starting NIV in the ICU&#44; the types of devices and ventilatory modes used&#44; the criteria used for performing ETI&#44; bicarbonate levels&#44; and associated comorbidities&#44; among others&#46; These variables were not fully reported in the study&#44; and may clarify the high rate of failure of NIV compared to other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Secondly&#44; the speed of the decision to perform ETI is a key factor in therapeutic response&#46; We consider a delay of 22<span class="elsevierStyleHsp" style=""></span>h before ETI to be very high&#44; and this may have resulted in the higher mortality and response to invasive MV&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Thirdly&#44; the authors consider that NIV failure was associated more with a situation of shock and worse response to NIV&#44; but this topic is controversial and&#44; as shown in a recent European survey&#44; the use of NIV is not absolutely contraindicated and first-line ETI may confer a higher risk&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; we do not know if the authors found an improvement in NIV outcomes after 10 years of use&#44; as reported in other series&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> so we conclude that further studies are necessary to confirm the role of NIV in non-COPD patients with hypercapnia&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Anoro L&#44; Esquinas AM&#44; Consentini R&#46; &#191;Ventilaci&#243;n no invasiva en pacientes con neumon&#237;a sin EPOC&#63; Efectos beneficiosos y aspectos a tener en cuenta para evitar potenciales complicaciones&#46; Arch Bronconeumol&#46; 2018&#59;54&#58;299&#8211;300&#46;</p>"
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