Abstract
Objective: Non-invasive ventilation (NIV) is widely used as part of the treatment of acute respiratory failure but it is not always successful. The purpose of this study is to determine if NIV failure can be predicted on the basis of information available at the initial point of contact with the patient. Methods: This is a retrospective study of patients admitted to a six bed non-specialized ICU at Koge University Hospital (Denmark) in the years 2011-2012. Patients were assigned to one of two groups covering successful NIV treatment and NIV failure. Results: 89 patients were included and the two groups were compared on variables available at the initial point of contact with the patient. Patients in whom NIV treatment failed had higher levels of C-reactive protein (p=0.04). Multivariate analysis showed an odds ratio of 1.13 (95% CI: 1.02-1.25) for NIV failure associated with increased respiratory rate. NIV was less likely to fail in patients with known Chronic Obstructive Pulmonary Disease (p=0.05). The mean duration of NIV before intubation in case of NIV failure was 14.1 hours (SD: 15.0) and was not associated with neither the ICU nor the in-hospital mortality. Conclusion: In the present study NIV failure was associated with higher levels of C-reactive protein and increased respiratory rates carried an odds ratio of 1.13 (95% CI: 1.02-1.25) for NIV failure.
Highlights
Non-invasive ventilation (NIV) is often considered part of the firstline treatment of acute respiratory failure (ARF) in selected patients with preserved respiratory drive [1,2]
Recent research has shown that the duration of NIV before intubation was shorter in survivors than non-survivors [3] among patients not previously diagnosed with cardiac or respiratory illness e.g. chronic obstructive pulmonary disease (COPD)
In patients initially treated with NIV but requiring invasive ventilation there was a trend toward a higher intensive care unit (ICU) mortality (20.0 vs. 10.2%, p=0.22) and a higher in-hospital mortality (33.3 vs. 15.3%, p=0.08) compared to patients successfully treated with NIV
Summary
Non-invasive ventilation (NIV) is often considered part of the firstline treatment of acute respiratory failure (ARF) in selected patients with preserved respiratory drive [1,2]. It is commonly used both in- and outside of the intensive care unit (ICU). In some patients NIV is not sufficient and they subsequently require invasive ventilation. The purpose of this study is to determine if NIV failure can be predicted on the basis of information available at the initial point of contact with the patient in acute respiratory failure. The variables being compared are those that are typically available when the choice between non-invasive and invasive ventilation has to be made and no distinction was made on the basis of co-existing disease
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