Limitations of care and comorbidities are associated with increased mortality in patients treated with non-invasive ventilation: A retrospective observational study in a single-center ICU.

Erik Svensk,Jakob Walldén,Jonas Tydén

doi:10.12688/f1000research.53841.1

Erik Svensk, Jakob Walldén + Show 1 more

Open Access

https://doi.org/10.12688/f1000research.53841.1

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Journal: F1000Research	Publication Date: Aug 27, 2021
License type: CC BY 4.0

Affiliation: Umeå University

Abstract

Background:Non-invasive ventilation (NIV) is a common treatment for acute respiratory failure in intensive care units (ICU). While there is increasing data on outcomes after NIV treatment, there are large variations in staffing and monitoring where NIV is provided, making results hard to generalize. The aim of this study was to characterize patients treated with NIV, describe outcomes, and identify factors associated with outcome in an ICU at a Swedish county hospital.Methods:A single-centre retrospective observational study during 2018 of patients treated with NIV in a six-bed ICU at a Swedish county hospital. Patient characteristics, including comorbidities, details of ICU stay, simplified acute physiology score (SAPS-3), details of NIV treatment and 30-day mortality were collected, and the Charlson co-morbidity index (CCI) was calculated. Primary outcomes were 30-day mortality and associated factors.Results:92 patients with mean age (71,3, SD 12,1) were treated with NIV during the study period. 42 (46%) were women. Median CCI was 3 (25th-75thpercentiles 1.4)) and median SAPS-3 score was 66 (25th-75thpercentiles 58). The 30-day mortality was 37% and in the univariate analysis, SAPS-3 score >66, Charlson comorbidity index, CCI>=3, pCO2 <5.5 and limitation of care were factors associated with increased 30-day mortality. pH <7.35 and pO2<8 at admission showed no associations with 30-day mortality.Conclusions:We found that patients treated with NIV in ICU were a diverse population where comorbidities and presence of limitations of care might be considered as better predictors of 30-day mortality, rather than physiological parameters.

Highlights

Non-invasive ventilation (NIV), i.e. respiratory support through a non-invasive interface such as a facemask or nasal prongs, is an evolving therapy with a broad application in intensive care units (ICU)[1,2,3]
The 30-day mortality was 37% and in the univariate analysis, SAPS-3 score >66, Charlson comorbidity index, CCI>=3, pCO2
We found that patients treated with NIV in ICU were a diverse population where comorbidities and presence of limitations of care might be considered as better predictors of 30-day mortality, rather than physiological parameters

Summary

Introduction

Non-invasive ventilation (NIV), i.e. respiratory support through a non-invasive interface such as a facemask or nasal prongs, is an evolving therapy with a broad application in intensive care units (ICU)[1,2,3]. NIV reduces the risks related to invasive mechanical ventilation in patients with acute respiratory failure in e.g. chronic obstructive pulmonary disease (COPD) and pneumonia[4]. Improper selection of patients and continuing treatment when NIV is not sufficient leads to unnecessary harm to the patients and delayed intubation and invasive mechanical ventilation, which is associated with increased mortality[10]. It has been shown that the patients with DNI orders treated with NIV for acute respiratory failure who survive have similar life quality after three months compared to patients without limitations of care[19]. Non-invasive ventilation (NIV) is a common treatment for acute respiratory failure in intensive care units (ICU). The aim of this study was to characterize patients treated with NIV, describe outcomes, and identify factors associated with outcome in an ICU at a Swedish county hospital

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