Non-invasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a prospective cohort study

Abstract

To investigate the clinical effect of non-invasive positive pressure ventilation (NPPV) on acute hypoxemic respiratory failure (AHRF), and to look for predictors of failure of NPPV in patients with AHRF. In the cohort study, the clinical data of patients with AHRF in respiratory intensive care unit (RICU) of Beijing Chaoyang Hospital from January 2004 to December 2007 were collected prospectively. Patients were divided into successful group and failure group according to outcome of NPPV. Basic clinical information, NPPV mode and duration, vital signs, arterial blood gas analysis, and oxygenation index (PaO(2)/FiO(2)) before and 2 hours, 24 hours after NPPV were analyzed and compared between two groups. (1)The NPPV successful rate in 59 cases was 62.7% (37/59). (2)Compared with failure group, mean age, the ratio of patients in whom respiratory failure were induced by pulmonary infection were lower in successful group (both P<0.01). There was no difference in PaO(2)/FiO(2)between two groups before NPPV, but PaO(2)/FiO(2) in successful group was markedly higher than those of failure group after 2 hours and 24 hours of NPPV (P<0.05 and P<0.01), while heart rate (HR), respiratory rate (RR) were significantly lower (all P<0.01). (3)Logistic regression analysis identified age > or = 60 years [odds ratio (OR) 8.30, 95% confidence interval (CI) 2.49-27.60, P=0.002], pulmonary infection as underlying disease of respiratory failure (OR 6.19, 95%CI 1.90-20.20, P=0.027), PaO(2)/FiO(2)<150 mm Hg (1 mm Hg=0.133 kPa) after 2 hours of NPPV (OR 3.65, 95%CI 1.20-11.04, P=0.044), HR>100 times/min after 24 hours of NPPV (OR 7.45, 95%CI 2.15-25.58, P=0.010), and RR>30 times/min after 24 hours of NPPV (OR 7.26, 95%CI 1.88-24.49, P=0.018) as risk factors independently associated with failure of NPPV. NPPV can be the first line treatment for severe AHRF patients without absolute contraindication, while patients of older age with pulmonary infection, the risk of failure of NPPV is higher. Lack of improvement in cardiorespiratory and oxygenation condition after a short period of NPPV is the predictor of NPPV failure.