Abstract
Background Risk factors for noninvasive ventilation (NIV) failure after initial success are not fully clear in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Patients who received NIV beyond 48 h due to acute exacerbation of COPD were enrolled. However, we excluded those whose pH was higher than 7.35 or PaCO2 was less than 45 mmHg which was measured before NIV. Late failure of NIV was defined as patients required intubation or died during NIV after initial success. Results We enrolled 291 patients in this study. Of them, 48 (16%) patients experienced late NIV failure (45 received intubation and 3 died during NIV). The median time from initiation of NIV to intubation was 4.8 days (IQR: 3.4–8.1). Compared with the data collected at initiation of NIV, the heart rate, respiratory rate, pH, and PaCO2 significantly improved after 1–2 h of NIV both in the NIV success and late failure of NIV groups. Nosocomial pneumonia (odds ratio (OR) = 75, 95% confidence interval (CI): 11–537), heart rate at initiation of NIV (1.04, 1.01–1.06 beat per min), and pH at 1–2 h of NIV (2.06, 1.41–3.00 per decrease of 0.05 from 7.35) were independent risk factors for late failure of NIV. In addition, the Glasgow coma scale (OR = 0.50, 95% CI: 0.34–0.73 per one unit increase) and PaO2/FiO2 (0.992, 0.986–0.998 per one unit increase) were independent protective factors for late failure of NIV. In addition, patients with late failure of NIV had longer ICU stay (median 9.5 vs. 6.6 days) and higher hospital mortality (92% vs. 3%) compared with those with NIV success. Conclusions Nosocomial pneumonia; heart rate at initiation of NIV; and consciousness, acidosis, and oxygenation at 1–2 h of NIV were associated with late failure of NIV in patients with COPD exacerbation. And, late failure of NIV was associated with increased hospital mortality.
Highlights
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death [1]
At initiation of noninvasive ventilation (NIV), there were no differences in respiratory rate, pH, and PaO2/ FiO2 between patients with NIV success and late failure of NIV
Compared with the variables collected at NIV initiation, respiratory rate, heart rate, pH, and PaCO2 collected at 1–2 h of NIV significantly improved both in NIV success and late failure of NIV groups (Figure 2)
Summary
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death [1]. Noninvasive ventilation (NIV) as an effective intervention has been used to manage patients with acute exacerbation of COPD for decades It improves pH, reduces respiratory rate, reduces PaCO2, and subsequently reduces intubation rate and mortality [3, 4]. Because of these advantages, use of NIV in patients with acute exacerbation of COPD has continuously increased in recent years [5, 6]. Risk factors for noninvasive ventilation (NIV) failure after initial success are not fully clear in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Patients with late failure of NIV had longer ICU stay (median 9.5 vs 6.6 days) and higher hospital mortality (92% vs 3%) compared with those with NIV success. Late failure of NIV was associated with increased hospital mortality
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