ObjectiveTo study whether noninvasive pressure support ventilation (NIPSV) with helium/oxygen (He/oxygen), which can reduce dyspnea, Paco2, and work of breathing more than NIPSV with air/oxygen in decompensated chronic obstructive pulmonary disease, could have beneficial consequences on outcome and hospitalization costs.DesignProspective, randomized, multicenter study.SettingIntensive care units of three tertiary care university hospitals.PatientsAll patients with chronic obstructive pulmonary disease admitted to the intensive care units for NIPSV during a 24-month period.InterventionsPatients were randomized to NIPSV with air/oxygen or He/oxygen. NIPSV settings, number of daily trials, decision to intubate, and intensive care unit and hospital discharge criteria followed standard practice guidelines.ResultsA total of 123 patients (male/female ratio, 71:52; age, 71 ± 10 yrs, Acute Physiology and Chronic Health Evaluation II, 17 ± 4) were included. Intubation rate (air/oxygen 20% vs. He/oxygen 13%) and length of stay in the intensive care unit (air/oxygen 6.2 ± 5.6 vs. He/oxygen 5.1 ± 4 days) were comparable. The post–intensive care unit hospital stay was lower with He/oxygen (air/oxygen 19 ± 12 vs. He/oxygen 13 ± 6 days,p< .002). Cost of NIPSV gases was higher with He/oxygen, but total hospitalization costs were lower by $3,348 per patient with He/oxygen. No complications were associated with the use of He/oxygen.ConclusionHe/oxygen did not significantly reduce intubation rate or intensive care unit stay, but hospital stay was shorter and total costs were lower. He/oxygen NIPSV can be safely administered and could prove to be a cost-effective strategy.