Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study.

Abstract

Noninvasive ventilation (NIV) is recommended for use in patients with acute respiratory failure of various etiologies. However, we do not know whether the use of NIV in general medical wards is safe and effective. This study aimed to evaluate the safety and efficacy of using NIV and factors associated with NIV failure in general medical wards. A prospective cohort study was conducted in general medical wards of the University Hospital. Adult patients with acute respiratory failure treated with NIV were enrolled. The subjects were managed by a multidisciplinary care team that was well trained in the NIV device. The primary outcome was the rate of NIV failure at 48 hours. Secondary outcomes included hospital mortality and factors associated with NIV failure. A total of 86 patients were enrolled. The mean age was 70±17 years old. The Acute Physiology and Chronic Health Evaluation (APACHE) III and the Sequential Organ Failure Assessment (SOFA) scores were 56±17 and 4±3, respectively. The most common indication of NIV use was cardiogenic pulmonary edema (34.9%). The rate of NIV failure at 48 hours and hospital mortality were 20.9% and 12.8%, respectively. The SOFA score was associated with failure of NIV at 48 hours [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.16-1.89; P=0.002]. NIV was safe and effective on general medical wards. Cardiogenic pulmonary edema was the most common indication for the application of NIV. The SOFA score was associated with the failure of NIV at 48 hours.