Outcomes of non-invasive ventilation use in intensive care unit: Results from a five years cohort

Abstract

Introduction: Non-invasive ventilation (NIV) is a recommended option of treatment for acute respiratory failure (ARF) in selected patients. But its use, especially in hypoxemic patients, is still controversial. Aim: Analyze the outcomes of NIV use for a 5 years period in a clinical-surgical adult intensive care unit (ICU) and comparer the results between hypoxemic and non-hypoxemic ARF. Methods: A retrospective cohort was carried out in the ICU of Hospital Santa Luzia, Brasilia-DF (Brazil) during 5 years (from January 2010 until December 2014). All patients that received NIV as treatment for ARF were included. Failure of NIV was considered when the patient ended requiring tracheal intubation and invasive mechanical ventilation. Patients selected were divided in 2 groups: hypoxemic ARF (HARF) and non-hypoxemic (nHARF). In the second group were included hypercapnia, acute pulmonary edema, post extubation and acute exacerbation of COPD. Patients were also divided in success group (SG) and failure group (FG). Results: 580 patients were enrolled in the study. Age was 71.0±16.8 years, APACHE II: 15.2±7.5 and 279 (48.1%) were hypoxemic ARF. The ICU length of stay (ICU-LOS) was 18.9±17.8 days and the hospital-LOS was 26.6±27.2 days. FG had 224 (38.6%) patients. NIV failure was significantly higher for the HARF group (43.7% x 33.9%, p = 0.02). The FG had higher ICU-LOS (23.4±21.6 x 16.1±14.2, p Conclusions: The success rate for the use of NIV in ARF is low for the hypoxemic patients and the failure leads to higher ICU LOS. Although it is the most prevalent group with ARF in the ICU studied.