Abstract
BackgroundNoninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study.MethodsWe conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (≥18 years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded.ResultsOut of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 60–84), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment.ConclusionsOur results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment.
Highlights
Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units
Several clinical trials designed to test the efficacy of NIV in 1990’s showed great mortality benefit among patients with an acute exacerbation of Chronic Obstructive Lung Disease (AECOPD) [6,7] and acute cardiogenic pulmonary edema (ACPE) [8,9,10]
Three hundred and sixty four patients developed ARF and were ventilated in intensive care unit (ICU), among which 146 (40%) were initiated on the NIV yielding a cumulative incidence of 180 episodes per 100,000 person-years (Figure 1)
Summary
Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. The data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Noninvasive mechanical ventilation (NIV) has been extensively used in the patients with acute respiratory failure (ARF) for more than two decades [1]. Before the start of NIV in intensive care unit (ICU) during 1990’s [2,3,4,5], most patients with ARF required endotracheal intubation and invasive mechanical ventilation (IMV), often complicated by airway injury, barotrauma, ventilation induced acute lung injury and ventilator associated pneumonia. NIV has been recognized as a way to palliate patients with ARF who wish to avoid intubation. Palliative NIV can either be administered to offer a chance for survival, or to alleviate the symptoms of respiratory distress in terminally ill patients [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
