NIV Failure Research Articles

Predicting outcomes in patients with exacerbation of COPD requiring mechanical ventilation

BackgroundAcute exacerbations of COPD (AECOPD) are common and significantly contribute to mortality in patients with COPD. Prognostic scores can assist clinicians in making tailored decisions to manage AECOPD. In the current study, we therefore aimed to evaluate the performance of the Noninvasive Ventilation Outcomes (NIVO) score, originally designed to assess in-ICU mortality, in predicting 1 year mortality and NIV failure in AECOPD.MethodsThis retrospective study analyzed data from patients hospitalized for AECOPD requiring mechanical ventilation between January 1st, 2018, and December 31st, 2022. Mortality was assessed at the end of ICU stay and 1 year after admission, while NIV failure was defined as intubation or death without intubation.ResultsAmong 302 ICU admissions of COPD patients, 190 patients with AECOPD requiring mechanical ventilation were included. Of these, 44 (23%) died in the ICU, 62 out of 184 (34%) failed NIV, and 78 (41%) died within 1 year of admission. Patients who died in ICU or experienced NIV failure had more severe COPD and more impaired blood gas parameters at admission. The NIVO score demonstrated an AUC of 0.68 in predicting 1-year mortality and an AUC of 0.85 in predicting NIV failure. A NIVO score over 7 was associated with higher 1-year mortality and NIV failure (HR of 4.4 [1.8–10.9] and 41.6 [5.6–307.9], respectively).ConclusionBeyond predicting in-ICU mortality, the NIVO-score is a reliable tool in predicting 1-year mortality and NIV failure in AECOPD.

Factor for Predicting Non-Invasive Ventilation Failure in Very Old Patients with Hypoxemic Respiratory Failure in Intensive Care Unit

Aims: This study aimed to investigate the efficacy of NIV in patients with pneumonia-associated acute hypoxemic respiratory failure (AHRF) and to identify factors that predict NIV failure. Methods: A total of 50 very elderly patients (aged 85 and older) with pneumonia-associated AHRF were retrospectively evaluated from January 2021 to August 2022. Failure of NIV was defined was characterized by a transition to mechanical ventilation (either through tracheal intubation or tracheostomy), discharge under "hopeless" conditions while still on NIV, or death during NIV. Results: The mean age of the patients was 87.4±2.4 years, median SOFA score was 5, median duration of NIV was 4 days, and median length of stay in the ICU for the patients was 7 days. It was determined that 48% of the patients experienced NIV failure due to worsening clinical conditions. The SOFA score, levels of procalcitonin, CRP, heart rate, and respiratory rate were higher in the NIV failure group compared to the NIV successful group. An increased SOFA score (OR= 1.51, 95% CI= 1.11-2.06, p= 0.009), elevated CRP levels (OR= 1.03, 95% CI= 1.01-1.05, p= 0.003), and increased respiratory rate (OR= 1.18, 95% CI= 1.01-1.38, p= 0.039) were identified as independent predictors of NIV failure. Conclusion: In very elderly patients with AHRF due to pneumonia, the use of NIV may offer a significant survival benefit if patients are closely monitored and potential risk factors such as systemic inflammation parameters, SOFA score, and respiratory rate are considered.

Respiratory alkalosis in the acute hypoxemic patient during non-invasive mechanical ventilation: troubleshooting and prognostic relevance

Respiratory alkalosis is one of the four basic disturbances to the acid-base equilibrium. Persistent primary respiratory alkalosis during non-invasive mechanical ventilation in patients with hypoxemic respiratory failure could be a risk factor for NIV failure. A 69-year-old man with acute hypoxemic respiratory failure caused by severe COVID-19 pneumonia demonstrated progressive worsening of gas exchange and clinical conditions. Despite a positive response to noninvasive mechanical ventilation, a therapeutic increase in respiratory support was required.

Neutrophil/Lymphocyte Ratio as a Predictive Biomarker of NIV Failure in AECOPD: The Unveiled Facts [Letter

Neutrophil/Lymphocyte Ratio as a Predictive Biomarker of NIV Failure in AECOPD: The Unveiled Facts [Letter

Clinical Outcomes according to Timing to Non Invasive Ventilation Initiation in COPD Patients with Acute Respiratory Failure: A Retrospective Cohort Study.

Nighttime and non-working days are characterized by a shortage of dedicated staff and available resources. Previous studies have highlighted that patients admitted during the weekend had higher mortality than patients admitted on weekdays ("weekend effect"). However, most studies have focused on specific conditions and controversial results were reported. We conducted an observational, monocentric, retrospective cohort study, based on data collected prospectively to evaluate the impact of the timing of NIV initiation on clinical outcomes in COPD patients with acute respiratory failure (ARF). A total of 266 patients requiring NIV with a time gap between diagnosis of ARF and NIV initiation <48 h were included. Interestingly, 39% of patients were not acidotic (pH = 7.38 ± 0.09 vs. 7.26 ± 0.05, p = 0.003) at the time of NIV initiation. The rate of NIV failure (need for intubation and/or all-cause in-hospital death) was similar among three different scenarios: "daytime" vs. "nighttime", "working" vs. "non-working days", "nighttime or non-working days" vs. "working days at daytime". Patients starting NIV during nighttime had a longer gap to NIV initiation compared to daytime (219 vs. 115 min respectively, p = 0.01), but this did not influence the NIV outcome. These results suggested that in a training center for NIV management, the failure rate did not increase during the "silent" hours.

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

BackgroundNon-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.MethodsWe analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2—2018 to 2019) and admitted due to COVID-19 (COVIP—March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).ResultsThe final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).ConclusionThe outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.

NIV failure in respiratory failure: an analysis

ObjectiveNoninvasive ventilation (NIV) has become an increasingly accepted mode of treatment for acute respiratory failure. Concept of NIV has revolutionized the treatment of acute respiratory failure in terms of the spectrum of diseases that can be successfully managed, the locations of its application, and achievable goals. The study was aimed at analyzing various aspects of NIV failure.Material and methodsIn this prospective observational study, all patients who underwent NIV therapy for acute respiratory failure from September 2019 to June 2020 were recruited. The clinical, radiological, laboratory and other relevant data from patients satisfying inclusion criteria were collected and analyzed using appropriate statistical tools.ResultsOut of the 96 NIV applications, 19 (19.8%) failed NIV application in the form of intubation in 12 and in-hospital mortality in 8 (8.3% of the total group). A total of 73.7% (14/19) had an early failure, and 26.3% (5/19) had late failure. The median length of hospital stay was significantly higher in NIV failure group compared to NIV success group (p < 0.001). NIV outcomes like failure rate, in-hospital mortality, and length of hospital stay did not have any difference between type 1 and type 2 ARF (p > 0.05). NIV failure and in-hospital mortality were found to be higher in patients with pneumonia and ILD group, respectively (p < 0.05). A baseline respiratory rate of more than 37 per minute, pH < 7.28, and pCO2 > 77 mm Hg measured 1–2 h after NIV initiation, hyponatremia, and prior NIV failure history were identified as the independent predictors of NIV failure. Using NIV as a treatment modality in respiratory failure secondary to pneumonia has more chances of failure (p < 0.05).ConclusionThough NIV is the preferred initial tool in the management of respiratory failure, it should be judiciously used when risk factors for failure are present. Early escalation or upfront use of invasive mechanical ventilation should be considered in such scenario to prevent undue mortality and morbidity in respiratory failure patients.Main points• Key point behind successful expansion of NIV is its capacity to achieve the same clinical outcomes as invasive ventilation with the avoidance of the complications associated with it.• Delay in identifying the patients who are likely to fail NIV can cause undue delay in intubation; this can lead to clinical deterioration and increased morbidity and mortality.• Predictors of NIV failure deciphered from this study are prior history of invasive mechanical ventilation following NIV failure, higher baseline respiratory rate, hyponatremia, low pH, and hypercapnia despite 1–2 h of NIV.

Abstract 9704: Role of Arterial Blood Gas Variables in the Prognostication of Patients With Acute Decompensated Heart Failure Admitted to Cardiac Intensive Care Unit

Introduction: Several risk factors and scores have been studied to predict in-hospital mortality [IHM] and rehospitalization [RH] in patients with AHF. Hypothesis: The impact of the initial therapies implemented for AHF on the variables of the acid base gases (ABG) has not been evaluated for prognostication of IHM and RH. Methods: We prospectively evaluated 216 patients admitted in CICU with AHF from 2015 to 2021. Demographic, clinical and ABG variables were analyzed on admission and at 24 hours. Patients were grouped according to whether they presented improvement in respiratory failure, defined as improvement in SaO2, PaO2 and PaCO2 as well as de-escalation of respiratory support devices (NIV or high flow). The aim of the study was to identify whether the improvement in ABG variables, O2 requirement or respiratory support within 24 hours of admission is associated with lower IHM and RH at 60 days. Data was analyzed using bivariate and multivariate analyzes by logistic regression. Results: Mean age was 75 years (44% female), normal EF 62% and reduced 38%. Mean NT-pro-BNP was 9280 ng/dl. RH at 60 days was 25% and IHM was 8.7%. Mean PaO2 on admission was 75 mmHg and at 24 hours 82 mmHg, PaCO2 on admission was 38 mmHg and at 24 hours 40 mmHg, mean SaO2 on admission was 94% and at 24 hours 95%. In bivariate analysis, the highest elevation of the PaCO2 on admission as well as PaCO2 at 24 hours were identified as predictors of IHM (38.42 vs 40.26 mmHg, p = 0.025) and (40.17 vs 46.84 mmHg, p = 0.002) respectively. In multivariate analysis, AKI on CKD (p = 0.03), cardiogenic shock (p = &lt;0.0001), acute myocardial infarction (p = &lt;0.004), emergency PCI (p = &lt;0.001), NIV failure (p = &lt;0.001), NT-pro-BNP (p = &lt;0.01), and elevated PaCO2 at 24 hours (p = 0.02) were identified as independent predictors for IHM. No association between the improvement in ABG variables and RH at 60 days was found. Conclusions: The lack of improvement in PaCO2 at 24 hours of admission to CICU for AHF identifies patients at higher risk for IHM. However, there was no association between the improvement ABG variables at 24 hours and the RH for AHF.

Comparison of clinical safety and efficacy of dexmedetomidine, remifentanil, and propofol in patients who cannot tolerate non-invasive mechanical ventilation: A prospective, randomized, cohort study.

Background and objectivesNon-invasive ventilation (NIV) is used in intensive care units (ICUs) to treat of respiratory failure. Sedation and analgesia are effective and safe for improving compliance in patients intolerant to NIV. Our study aimed to evaluate the effects of dexmedetomidine, remifentanil, and propofol on the clinical outcomes in NIV intolerant patients.MethodsThis prospective randomized cohort study was conducted in a tertiary ICU, between December 2018 and December 2019. We divided a total of 120 patients into five groups (DEXL, DEXH, REML, REMH, PRO). IBM SPSS Statistics 20 (IBM Corporation, Armonk, New York, USA) was used to conduct the statistical analyses.ResultsThe DEXL, DEXH, REML, and REMH groups consisted of 23 patients each while the PRO group consisted of 28 patients. Seventy-five patients (62.5%) became tolerant of NIV after starting the drugs. The NIV time, IMV time, ICU LOS, hospital LOS, intubation rate, side effects, and mortality were significantly different among the five groups (P = 0.05). In the groups that were given dexmedetomidine (DEXL, and DEXH), NIV failure, mortality, ICU LOS, and hospital LOS were lower than in the other groups.ConclusionIn this prospective study, we compared the results of three drugs (propofol, dexmedetomidine, and remifentanil) in patients with NIV intolerance. The use of sedation increased NIV success in patients with NIV intolerance. NIV failure, mortality, ICU LOS, IMV time, and hospital LOS were found to be lower with dexmedetomidine.

Early prediction of noninvasive ventilation failure after extubation: development and validation of a machine-learning model

BackgroundNoninvasive ventilation (NIV) has been widely used in critically ill patients after extubation. However, NIV failure is associated with poor outcomes. This study aimed to determine early predictors of NIV failure and to construct an accurate machine-learning model to identify patients at risks of NIV failure after extubation in intensive care units (ICUs).MethodsPatients who underwent NIV after extubation in the eICU Collaborative Research Database (eICU-CRD) were included. NIV failure was defined as need for invasive ventilatory support (reintubation or tracheotomy) or death after NIV initiation. A total of 93 clinical and laboratory variables were assessed, and the recursive feature elimination algorithm was used to select key features. Hyperparameter optimization was conducted with an automated machine-learning toolkit called Neural Network Intelligence. A machine-learning model called Categorical Boosting (CatBoost) was developed and compared with nine other models. The model was then prospectively validated among patients enrolled in the Cardiac Surgical ICU of Zhongshan Hospital, Fudan University.ResultsOf 929 patients included in the eICU-CRD cohort, 248 (26.7%) had NIV failure. The time from extubation to NIV, age, Glasgow Coma Scale (GCS) score, heart rate, respiratory rate, mean blood pressure (MBP), saturation of pulse oxygen (SpO2), temperature, glucose, pH, pressure of oxygen in blood (PaO2), urine output, input volume, ventilation duration, and mean airway pressure were selected. After hyperparameter optimization, our model showed the greatest accuracy in predicting NIV failure (AUROC: 0.872 [95% CI 0.82–0.92]) among all predictive methods in an internal validation. In the prospective validation cohort, our model was also superior (AUROC: 0.846 [95% CI 0.80–0.89]). The sensitivity and specificity in the prediction group is 89% and 75%, while in the validation group they are 90% and 70%. MV duration and respiratory rate were the most important features. Additionally, we developed a web-based tool to help clinicians use our model.ConclusionsThis study developed and prospectively validated the CatBoost model, which can be used to identify patients who are at risk of NIV failure. Thus, those patients might benefit from early triage and more intensive monitoring.Trial registration: NCT03704324. Registered 1 September 2018, https://register.clinicaltrials.gov.

Factors Associated with and Prognosis Impact of Perceived Sleep Quality and Estimated Quantity in Patients Receiving Non-Invasive Ventilation for Acute Respiratory Failure.

Background. The objectives of this study were (1) to determine factors associated with impaired sleep and (2) to evaluate the relationship between impaired sleep and the outcome. Methods. Secondary analysis of a prospective observational cohort study in 54 intensive care units in France and Belgium. Sleep quality was quantified by the patients with a semi-quantitative scale. Results. Among the 389 patients included, 40% reported poor sleep during the first night in the ICU and the median (interquartile) total sleep time was 4 h (2–5). Factors independently associated with poor sleep quality were the SOFA score (odds ratio [OR] 0.90, p = 0.037), anxiety (OR 0.43, p = 0.001) and the presence of air leaks (OR 0.52, p = 0.013). Factors independently associated with short-estimated sleep duration (<4 h) were the SOFA score (1.13, p = 0.005), dyspnea on admission (1.13, p = 0.031) and the presence of air leaks (1.92, p = 0.008). Non-invasive ventilation failure was independently associated with poor sleep quality (OR 3.02, p = 0.021) and short sleep duration (OR 0.77, p = 0.001). Sleep quality and duration were not associated with an increase in mortality or length of stay. Conclusions. The sleep of patients with ARF requiring NIV is impaired and is associated with a high rate of NIV failure.

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study

BackgroundNoninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV.MethodsThis is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality.ResultsCohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876).ConclusionsFrequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV.Clinical Trial RegistrationNCT04321265, registered 19 March 2020, https://clinicaltrials.gov.

Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community acquired pneumonia; an Egyptian multicenter prospective study

Abstract Funding Acknowledgements Type of funding sources: None. Background Non-invasive ventilation (NIV) might be successful if properly selected in adult patients with cardiac dysfunction presenting with community acquired pneumonia. The main objective was to identify contributing factors to NIV failure. Methods All adult patients with LV EF less than 50% admitted to the ICU with community acquired pneumonia and acute respiratory failure were enrolled in our multicenter prospective study after getting informed consents . The study was registered and given a number (ID ISRCTN14641518). Non-invasive ventilation failure was defined as requirement of intubation after institution of NIV intervention. Results We prospectively enrolled 177 patients between February 2019 to July 2020. Fifty-three patients (29.9%) were considered failed NIV. The mean age of studied patients was 64.1±12.6 years with a male predominance (73.4%) and a mean left ventricle EF of 36.4±7.8%. There were insignificant differences between the NIV success and NIV failure groups regarding the underlying morbidities nor the inflammatory markers. The patients who failed NIV were significantly older with higher mean SOFA and APACHE II scores compared to the patients with succeeded NIV. Non-invasive Ventilation failure was associated with longer ICU stay (p&amp;lt;0.001), higher SOFA at 48 hours (p&amp;lt;0.001) and higher mortality (p&amp;lt;0.001) compared to the NIV success group. NIV failure was independently predicted with APACHE II (OR:1.420, p 0.01, 95% CI:1.224 – 1.647), SOFA (OR:17.6 , p &amp;lt;0.001, 95% CI: 4.148-74.68), baseline HACOR (OR:2.041, P 0.026, 95% CI:1.225 –3.401), lung ultrasound score (OR:1.209,P 0.017,95% CI:1.014–1.441) and blood lactate (OR:9.702,P &amp;lt;0.001,95%CI:1.357–69.37).Conclusion: High initial APACHE II and SOFA scores , hindered lactate clearance as well as non-decrementing patterns of HACOR and LUS scores were associated with early NIV failure in patients with heart failure presenting with community acquired pneumonia.

Mechanical Ventilation for COVID-19 Patients.

Non-invasive ventilation (NIV) or invasive mechanical ventilation (MV) is frequently needed in patients with acute hypoxemic respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While NIV can be delivered in hospital wards and nonintensive care environments, intubated patients require intensive care unit (ICU) admission and support. Thus, the lack of ICU beds generated by the pandemic has often forced the use of NIV in severely hypoxemic patients treated outside the ICU. In this context, awake prone positioning has been widely adopted to ameliorate oxygenation during noninvasive respiratory support. Still, the incidence of NIV failure and the role of patient self-induced lung injury on hospital outcomes of COVID-19 subjects need to be elucidated. On the other hand, endotracheal intubation is indicated when gas exchange deterioration, muscular exhaustion, and/or neurological impairment ensue. Yet, the best timing for intubation in COVID-19 is still widely debated, as it is the safest use of neuromuscular blocking agents. Not differently from other types of acute respiratory distress syndrome, the aim of MV during COVID-19 is to provide adequate gas exchange while avoiding ventilator-induced lung injury. At the same time, the use of rescue therapies is advocated when standard care is unable to guarantee sufficient organ support. Nevertheless, the general shortage of health care resources experienced during SARS-CoV-2 pandemic might affect the utilization of high-cost, highly specialized, and long-term supports. In this article, we describe the state-of-the-art of NIV and MV setting and their usage for acute hypoxemic respiratory failure of COVID-19 patients.

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

A combination of the APACHE II score, neutrophil/lymphocyte ratio, and expired tidal volume could predict non-invasive ventilation failure in pneumonia-induced mild to moderate acute respiratory distress syndrome patients.

BackgroundNoninvasive ventilation (NIV) failure rate is relatively high in patients with acute respiratory distress syndrome (ARDS). Currently the data regarding prediction of NIV failure of pneumonia-induced mild to ARDS patients were scarce.MethodsA total of 364 patients (from January 2016 to December 2020) diagnosed with hypoxemic respiratory failure and managed with NIV were initially included and finally 131 pneumonia-induced mild to moderate ARDS patients were enrolled in this study. Electronic medical records were reviewed to determine whether NIV succeeded or failed for each patient. The relationship between the Acute Physiology And Chronic Health Evaluation II (APACHE II) score , neutrophil/lymphocyte ratio (NLR), expired tidal volume (Vte) and NIV failure were specifically analyzed. Multivariate logistic regression analyses were conducted to identify the independent factors of NIV failure. Receiver-operating characteristic curves were used to assess the efficacy of the variables in predicting NIV failure. Kaplan-Meier curves for 28-day survival were used to compare the mortality rates of different groups.ResultsOf the patients, 64 (48.9%) experienced NIV failure, APACHE II score [odds ratio (OR) =0.77; P=0.002], NLR (OR =0.838; P=0.046), and Vte (OR =0.343; P=0.009) were independent factors for predicting NIV failure. A combined value comprising the APACHE II score, NLR, and Vte had better efficacy at predicting NIV failure [area under the curve (AUC) =0.9; 95% confidence interval (CI): 0.845–0.955] than the APACHE II score (AUC =0.818; 95% CI: 0.745–0.891), NLR (AUC =0.839; 95% CI: 0.765–0.913), or Vte (AUC =0.805; 95% CI: 0.729–0.881) alone. The cumulative survival probability within 28 days was lower in patients with a combined value >59.17 (P<0.001 by the log-rank test), an APACHE II score >16.5 (P<0.001 by the log-rank test), an NLR >7.22 (P<0.001 by the log-rank test), and a Vte >8.96 mL/kg (P<0.001 by log-rank test).ConclusionsA combined value comprising an APACHE II score >16.5, a NLR >7.22, and a Vte >8.96 mL/kg may be a useful surrogate for predicting NIV failure among pneumonia-induced ARDS patients, and patients with a combined value >59.17 should be cautiously monitored during NIV. A further study with a larger sample size is warranted.

Non-invasive High-Frequency Oscillatory Ventilation as Initial Respiratory Support for Preterm Infants With Respiratory Distress Syndrome.

Objectives: The aim of this study was to investigate the safety and feasibility of nHFOV as initial respiratory support in preterm infants with RDS.Methods: This study retrospectively analyzed the clinical data of 244 premature infants with RDS who were treated in our hospital from January 2016 to January 2019 and divided into the nHFOV group (n = 115) and the BiPAP group (n = 129) based on the initial respiratory support method.Results: Respiratory outcomes showed that the rate of NIV failure during the first 72 hours of life in the nHFOV group was significantly lower than that in the BiPAP group. The time of NIV in the nHFOV group was significantly shorter than that in the BiPAP group. The time of supplemental oxygen in the nHFOV group was significantly shorter than that in the BiPAP group. The incidence of air leakage syndrome in the nHFOV group was significantly lower than that in the BiPAP group, and the length of hospital stay of the nHFOV group was also significantly shorter than that in the BiPAP group. Although the rate of infants diagnosed with BPD was similar between the two groups, the rate of severe BPD in the nHFOV group was significantly lower than that in the BiPAP group.Conclusion: This study showed that nHFOV as initial respiratory support for preterm infants with RDS was feasible and safe compared to BiPAP. Furthermore, nHFOV can reduce the need for IMV and reduce the incidence of severe BPD and air leak syndrome.

Evolución de los pacientes con insuficiencia cardiaca aguda secundaria a infarto agudo de miocardio tratados con ventilación mecánica no invasiva

Introduction and objectivesNoninvasive ventilation (NIV) has been shown to reduce the rate of endotracheal intubation and mortality in patients with acute heart failure (AHF). However, patients with AHF secondary to acute coronary syndrome/acute myocardial infarction (ACS-AMI) have been excluded from many clinical trials. The purpose of this study was to compare the effectiveness of NIV between patients with AHF triggered by ACS-AMI and by other etiologies. MethodsProspective cohort study of all patients with AHF treated with NIV admitted to the intensive care unit for a period of 20 years. Patients were divided according to whether they had ACS-AMI as the cause of the AHF episode. NIV failure was defined as the need for endotracheal intubation or death. ResultsA total of 1009 patients were analyzed, 403 (40%) showed ACS-AMI and 606 (60%) other etiologies. NIV failure occurred in 61 (15.1%) in the ACS-AMI group and in 64 (10.6%) in the other group (P=.031), without differences in in-hospital mortality (16.6% and 14.9%, respectively; P=.478). ConclusionsThe presence of ACS-AMI as the triggering cause of AHF did not influence patients with acute respiratory failure requiring noninvasive respiratory support.

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

Background/aim To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure.Material and methodsThis prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis.Results Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026). The failure rate was 13.4%. sepsis, ARDS, prolonged intubation, and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in 5 (10.6%), neurological deterioration in 4 (8.5%) and developing ARDS in 3 (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR: 9.841, 95% CI: 2.0021–48.3742). FiO2 > 55% at 6th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on 16 children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC)ConclusionAbsence of reduction in the respiration rate within an hour, FiO2 requirement >55% at 6th hours and PRISM-3 score >8 predict NIV failure.

Outcome of patients with acute heart failure secondary to acute myocardial infarction treated with noninvasive mechanical ventilation

Introduction and objectivesNoninvasive ventilation (NIV) has been shown to reduce the rate of endotracheal intubation and mortality in patients with acute heart failure (AHF). However, patients with AHF secondary to acute coronary syndrome/acute myocardial infarction (ACS-AMI) have been excluded from many clinical trials. The purpose of this study was to compare the effectiveness of NIV between patients with AHF triggered by ACS-AMI and by other etiologies. MethodsProspective cohort study of all patients with AHF treated with NIV admitted to the intensive care unit for a period of 20 years. Patients were divided according to whether they had ACS-AMI as the cause of the AHF episode. NIV failure was defined as the need for endotracheal intubation or death. ResultsA total of 1009 patients were analyzed, 403 (40%) showed ACS-AMI and 606 (60%) other etiologies. NIV failure occurred in 61 (15.1%) in the ACS-AMI group and in 64 (10.6%) in the other group (P=.031), without differences in in-hospital mortality (16.6% and 14.9%, respectively; P=.478). ConclusionsThe presence of ACS-AMI as the triggering cause of AHF did not influence patients with acute respiratory failure requiring noninvasive respiratory support.