Morbimortality of patients treated with noninvasive mechanical ventilation

Abstract

Noninvasive mechanical ventilation (NIV) has been established as a successful therapeutic option in acute respiratory failure (ARF) from specific etiologies. Objectives: Evaluate the morbimortality of patients with ARF treated with NIV in a medical intermediate care unit (IMCU). Identify factors associated with higher in-hospital and 6-month mortality rate as well as higher 3 and 6-month hospital readmission rate. Methods: A retrospective cohort study was performed including patients admitted for ARF treated with NIV in an IMCU in 31 months. Exclusion criteria: ambulatory use of NIV, NIV as a rescue technique from IMV, ARF caused by a neurologic disease. Results: 137 patients were included with a median age of 82 years (IQR: 75,87) and a female predominance (53%). 24% were on long-term oxygen therapy (LOT), 58% had do-not resuscitate order, median Charlson (CCI) and Barthel score (BSI) at admission were 6 (IQR: 5,8) and 35 (IQR: 20,65) respectively. SAPS II score were 36±11. 88% of patients had type 2 ARF. Median NIV days globally and in IMCU were 9 (IQR: 5,15) and 6 (IQR: 3,10) respectively. The main conditions requiring IMCU admission to NIV were heart failure (73%), pneumonia (48%) and chronic obstructive lung disease (37%). NIV failure rate was 9%. Average BSI of 40 (IQR:10,63) at discharge. In-hospital mortality rate was 24%. Age, SAPS II, CCI and the number of days under NIV were identified as factors associated with higher in-hospital mortality. LOT were associated with higher 3-month mortality. BSI at time of hospital discharge was associated with a higher 6-month readmission rate. Conclusion: NIV can be used successfully in elderly patients and in less studied ARF causes like pneumonia.