Abstract
In the last years noninvasive ventilation (NIV) is used increasingly worldwide in treatment of acute respiratory failure (ARF). The evidence strongly supports NIV use in patients with ARF, especially for chronic obstructive pulmonary disease (COPD) ex-acerbations and acute cardiogenic pulmo-nary edema. The efficacy of NIV depends on several factors like the experience of medical team, adequate selection of patient and inter-face and appropriate ventilator settings. This is a retrospective analysis of patients with ARF treated by NIV in the medical in-tensive care unit (ICU), University Hospital Sveti Duh, between January 2015 and Janu-ary 2016.Analysis of statistical hospital data showed steady increments in NIV utilization from year 2011 (7%) to 2015 (15.7%). The mean age of studied patients was 69.8 years, 58.3% were male and 41.7% female. Four ma-jor causes for applying NIV were: COPD (41.7%), pneumonia (25%), acute cardio-genic pulmonary edema (19.4%) and other reasons (13.9%). Of 108 patients 93 (86.1%) were successfully treated with NIV and 15 (13.9%) were intubated. A number of randomized clinical trials sup-port the use of NIV in patients with ARF and beside the beneficial role in reducing patients symptoms it showed reduction in morbidity, mortality and length of stay in ICU. Failure rates of NIV still range from 25% to 40%, and optimization of NIV success rates requires careful patient selection and knowledge of proper application and monitoring tech-niques. If a patient fails to improve sufficient-ly, prompt endotracheal intubation should be performed without delay.
Highlights
Acute respiratory failure (ARF) is a common reason for admission to intensive care unit (ICU)
Because NIV avoids airway invasion it has less infectious complications like ventilator associated pneumonia (VAP) and it is beneficial in immunocompromised patients with ARF. [2,3] The aim of this study was to analyse NIV utilization in a medical ICU, characteristics of patients with ARF treated by NIV, the rate of NIV failure and patient outcome
(4) Multiple randomized studies showed benefit of this therapy in patents with ARF in particular in chronic obstructive pulmonary disease (COPD) exacerbations and congestive heart failure with mild-to-moderate pulmonary edema, and pulmonary edema from hypervolemia. [5,6] In a Cochrane review including 14 randomized clinical trials (RCTs) for the treatment of COPD exacerbations it was reported that NIV and usual care compared with usual care alone decreased the need for intubation and mortality
Summary
Acute respiratory failure (ARF) is a common reason for admission to intensive care unit (ICU). Hypoxemic or type I is characterized by oxygen arterial pressure (PaO2) lower than 60 mmHg with normal or lower carbon dioxide arterial pressure (PaCO2) This is the most common form of ARF and is seen in almost all acute lung diseases like pneumonia and acute cardiogenic pulmonary edema. Hypercapnic or type II is characterized by PaCO2 higher than 50 mmHg and is usually accompanied with hypoxemia This type of ARF is seen in patients with chronic obstructive pulmonary disease (COPD) and neuromuscular diseases. [1] Therapy of ARF is directed to both the correction of blood gas abnormality as well as treatment of underlying disease Mechanical ventilation, both noninvasive (NIV) and invasive, plays an important role in therapy of ARF. Because NIV avoids airway invasion it has less infectious complications like ventilator associated pneumonia (VAP) and it is beneficial in immunocompromised patients with ARF. [2,3] The aim of this study was to analyse NIV utilization in a medical ICU, characteristics of patients with ARF treated by NIV, the rate of NIV failure and patient outcome
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