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Among these eight patients, seven patients developed recurrence of AHcRF, and one patient had deteriorating symptoms requiring recommencement of NIV In the immediate withdrawal group (n?=?25), 11 patients failed to be withdrawn from NIV. Among them, 10 patients had recurrence of AHcRF within 48?h of NIV withdrawal, and one patient had deteriorating symptoms requiring recommencement of NIV. Therefore, by intention-to-treat analysis, Mianserin HCl 26 out of 35 patients (74.3%) in the stepwise withdrawal group and 14 out of 25 patients (56%) in the immediate withdrawal group reached the primary study end-point of success in withdrawal from NIV (>48?h) (P?=?0.139) (Table?4). Because six patients in the stepwise withdrawal group had immediate termination of NIV upon resolution of AHcRF, and did not complete the stepwise withdrawal protocol, a supplementary per-protocol analysis was also performed on the remaining 29 patients who have completed the study protocol. By the per-protocol analysis, 21 out of 29 patients (72.4%) in the stepwise withdrawal group succeeded in withdrawal from NIV compared with 14 out of 25 patients (56%) in the immediate withdrawal group (P?=?0.208). None of the patients who succeeded in withdrawal of NIV in both groups had subsequent check details recurrence of AHcRF throughout the whole episode of admission. The median duration of non-invasion ventilation after randomization was 3 days (interquartile range 3�C3) in the stepwise withdrawal group and 0 day (interquartile range 0�C3) in the immediate withdrawal group, respectively (P?Epigenetic inhibitor and the immediate withdrawal groups, respectively (P?=?0.001) (Table?4). There was no statistically significant difference in the length of stay in the acute hospital from randomization to discharge in patients in the two groups. The median time to discharge was 5 days in both groups (P?=?0.14). Two patients died during the study period, both were in the stepwise withdrawal group. One of them withdrew consent and was removed from the study, and he eventually died of pneumonia. Another patient failed to be withdrawn from NIV, and was removed from the study and died of gastrointestinal bleeding. None of the deaths were study related. Our study compared stepwise withdrawal with immediate withdrawal of NIV in patients with COPD exacerbation and AHcRF, after the AHcRF has resolved with NIV treatment. There were no differences noted between the groups. Although the duration of NIV use was statistically significantly shorter in the immediate withdrawal group, this may be a result of the study design. We did not demonstrate any significant difference in withdrawal success rate between the immediate and stepwise withdrawal groups.