LATE-BREAKING ABSTRACT: Predictors of non-invasive ventilation failure in patients with acute cardiogenic pulmonary edema: A prospective, observational, cohort study

Abstract

Introduction: Non-invasive ventilation (NIV) is increasingly being used in patients presenting with acute cardiogenic pulmonary edema (ACPE). However, delayed identification of patients who fail NIV may lead to increased mortality. Our aim was to identify early predictors of NIV failure, so as to alert clinicians early that invasive mechanical ventilation might be appropriate. Methods: We conducted an observational cohort study over a 3-year period in a 28-bed emergency intensive care unit (EICU), and prospectively included all consecutive patients in whom a trial of NIV was attempted as initial ventilatory support for the presence of ACPE. The primary outcome variables were NIV failure rate, and risk factors associated with NIV failure. Results: Of 118 patients who were eligible for study participation, NIV was successful in avoiding endotracheal intubation in 74 (62.7%) patients and failed for 44 (37.3%). Risk factors associated with NIV failure were presence of killip class IV (odds ratio [OR], 28.56; 95% confidence interval [CI], 2.17-375.73; P =.011), left ventricular ejection fraction (LVEF) Conclusions: NIV failure occurs in 37.3% of the patients with ACPE in a “real-life” clinical practice of EICU. When patients had a killip class IV, a lower LVEF, a higher BNP, and a more positive fluid balance within 24 hours after presence of ACPE, the risk of failure was higher.