Predictive Factors Of Noninvasive Ventilation Failure Research Articles

Predictive factors for noninvasive mechanical ventilation failure among COVID-19 critically ill patients - a retrospective cohort study.

Aim To identify predictive factors related with noninvasive ventilation (NIV) failure that are not based on the patient's respiratory status or acid base gas analyses in COVID-19 critically ill patients, and to create a predictive model of NIV failure. Methods A total of 73 COVID-19 critically ill patients who developed acute respiratory failure and underwent NIV were divided into two groups: Group 1, patients who required endotracheal intubation and invasive mechanical ventilation after NIV and Group 2, patients with successful weaning from NIV. Demographic data, clinical symptoms and signs, clinical index and scores, duration indicators and laboratory data were analysed. Predictive factors of NIV failure were assessed using univariate and multivariate regression analyses followed by the receiver operating characteristic (ROC) curve. Results In the Group 1 (NIV failure) there were 54 (73.97%) patients. Predictive factors for NIV failure were: the presence of dyspnoea on the day of admission at hospital (p<0.05; sensitivity 44.40%; specificity 84.20%), higher radiographic assessment of lung oedema score (RALES) on the day of starting NIV (p<0.009; sensitivity 70.40%; specificity 73.75%), higher length of NIV (p<0.014; sensitivity 48%; specificity 84.10%) and higher urea on the day of starting NIV (p<0.004; sensitivity 70.44%; specificity 73.72%) Conclusion NIV treatment in COVID-19 critically ill patients has a high failure rate. In addition to respiratory parameters, dyspnoea, higher RALES, higher length of NIV and increased urea value could predict NIV failure. These factors should be considered in treatment decision making.

What are the most reliable predictive factors of non-invasive ventilation failure in paediatric intensive care units?

IntroductionDespite there being limited evidence, non-invasive ventilation (NIV) has become a common treatment for acute respiratory failure (ARF). The aim of this study was to identify the predictive factors of NIV failure, in order to enable early detection of patients failing the treatment. Patients and methodsProspective cohort study was conducted that included all ARF patients that received NIV as the initial treatment between 2005 and 2009 in a fourteen-bed Paediatric Intensive Care Unit (PICU) of a tertiary university hospital. Information was collected about the NIV, as well as clinical data prior to NIV, at 2, 8, 12, and 24h. The haemoglobin saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (S/F) was retrospectively calculated. NIV failure was defined as the need for intubation or requiring rescue with bi-level pressure (BLPAP). Univariate and multivariate statistical analyses were performed. ResultsA total of 282 patients received non-invasive support, with 71 receiving Continuous Pressure (CPAP), and 211 with BLPAP treatment. The overall success rate was 71%. Patients receiving BLPAP vs. CPAP, patients with higher S/F ratios at 2h (odds ratio [OR] 0.991, 95% CI: 0.986–0.996, P=.001), and patients older than 6 months (Hazard ratio [HZ] 0.375, 95% CI: 0.171–0.820, P=.014), were also more likely to fail. Patients with higher heart rates (HR) at 2h (OR 1.021, 95% CI [1.008–1.034], P=.001) and higher inspiratory positive airway pressure (IPAP) at 2h were more prone to failure (HZ 1.214, 95% CI [1.046–1.408], P=.011). ConclusionsAge below 6 months, S/F ratio, HR, and IPAP at 2h are independent predictive factors for initial NIV failure in paediatric patients with ARF admitted to the PICU.

Non-invasive ventilation improves respiratory distress in children with acute viral bronchiolitis: a systematic review.

Non-invasive ventilation (NIV) is a common treatment for bronchiolitis. However, consensus concerning its efficacy is lacking. The aim of this systematic review was to assess NIV effectiveness to reduce respiratory distress. Secondary objectives were to summarize the effects of NIV, identify predictive factors for failure and describe settings and applications. Literature searches were conducted in MEDLINE/PubMed, PEDro, Cochrane, EMBASE, CINAHL, Web of Science, UpToDate, and SuDoc from 1990 to April 2015. Randomized controlled trials, controlled non-randomized trials and prospective studies of NIV (continuous positive airway pressure [CPAP], bi-level CPAP, or neurally-adjusted ventilator assist) for bronchiolitis in infants younger than 2 years were included. Fourteen studies were included, for a total of 379 children. Of these, 357 were treated with NIV as first intention. Respiratory distress, heart rate, respiratory rate and respiratory effort improved (P<0.05). Results were inconclusive regarding prevention of endotracheal intubation. Few adverse events were reported. NIV reduced carbon dioxide pressure (pCO2) in 10 studies. Two randomized controlled studies reported a decrease of 7 mmHg in pCO2 (P<0.05). Predictive factors of NIV failure were apneas, high pCO2, young age, low weight, elevated heart rate and high pediatric risk of mortality score. NIV is mostly administered through a nasal mask, nasal cannula or helmet, with an initial expiratory positive airway pressure of 7 cmH2O. NIV shows promising results for the reduction of respiratory distress in acute viral bronchiolitis, as shown in several recent studies. However, there is a lack of robust studies to confirm this.

Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units : Precision medicine in intermediate care units.

BackgroundSevere acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS.MethodsWe prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH ≥ 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure.ResultsWe included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 ± 7.2 and 19 ± 5.8 for the ACPE patients (p < 0.05), 20 ± 5.7 and 19 ± 5.1 for the COPD patients (p < 0.01) and 18 ± 5.9 and 17 ± 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 ± 22 and 70 ± 15 in the ACPE patients (p < 0.001), 87 ± 21 and 76 ± 14 in the COPD patients, and 83 ± 17 and 74 ± 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 ± 3.1 vs. 3.6 ± 2.5, NS; COPD, 5.1 ± 3 vs. 3.6 ± 2.1, p < 0.001; and OHS, 4.3 ± 2.6 vs. 3.7 ± 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups.ConclusionsACPE, COPD and OHS patients with AHRF and severe acidosis (pH ≤ 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0262-9) contains supplementary material, which is available to authorized users.

PS-140 ¿should Be Look At Tidal Volumen/weight Value As A Predictive Factor For Non-invasive Ventilation Failure?

Background and aims Expected normal tidal volume values have not been described in children treated on NIV yet. Describe tidal volumen/weight (V T /W) values according to the ventilators and interface used while receiving non-invasive ventilation (NIV) in the Paediatric Intensive Care Unit (PICU). Methods Prospective study done in 4 Spanish PICU of University Hospitals during 2013. Consecutive register using a dataweb (www. NIVresearch.net), of patients diagnosed with acute respiratory failure (ARF) treated with NIV. V T /W was measured at the beginning of NIV, 1, 2, 6, 12 and 24 h. Failure was defined as need for intubation. Bonferroni’s adjust for mean comparison was used. Results 607 episodes were included. 58% male. Median age was 11.3 months (P25 2.1–P75 60.5). Mean values V T /W (ml/kg) between groups success/failure were: starting NIV was 9.4 ± 5 DS vs 8.3 ± 3.4 DS, at 1 h 8.5 ± 4DS vs 7 ± 3DS ( p 0.02 ), at 2 h 9.2 ± 5 DS vs 7.8 ± 6DS, at 6 h 9.7 ± 5.4 DS vs 8.5 ± 3.8DS, at 12 h 9 ± 5DS vs 9.5 ± 14DS and at 24 h 9 ± 4,8DS vs 10.6 ± 8DS. Mean V T /W shows significant differences between BiPAP Vision and conventional ventilator at start point (p 0.022), 1 h (p 0.01), 6 h (p 0.016), 12 h (p 0.01), 24 h (p 0.01). Differences of V T /weight between several types of interfaces reached statistical significance. Conclusions V T /weight differs differs according to the ventilator and interface used. V T /weight differences between success and failure group suggest that this variable could be a new predictive factor for NIV failure. Further studies with multivariable adjustment should explore this hypothesis.

Postoperative Respiratory Failure After Cardiac Surgery: Use of Noninvasive Ventilation

To analyze the use of noninvasive ventilation (NIV) in respiratory failure after extubation in patients after cardiac surgery, the factors associated with respiratory failure, and the need for reintubation. Retrospective observational study. Intensive care unit in a university hospital. Patients (n = 63) with respiratory failure after extubation after cardiac surgery over a 3-year period. Mechanical NIV. Demographic and surgical data, respiratory history, causes of postoperative respiratory failure, durations of mechanical ventilation and spontaneous breathing, gas exchange values, and the mortality rate were recorded. Of 1,225 postsurgical patients, 63 (5.1%) underwent NIV for respiratory failure after extubation. The median time from extubation to the NIV application was 40 hours (18-96 hours). The most frequent cause of respiratory failure was lobar atelectasis (25.4%). The NIV failed in 52.4% of patients (33/63) who had a lower pH at 24 hours of treatment (7.35 v 7.42, p = 0.001) and a higher hospital mortality (51.5% v 6.7%, p = 0.001) than those in whom NIV was successful. An interval <24 hours from extubation to NIV was a predictive factor for NIV failure (odds ratio, 4.6; 95% confidence interval, 1.2-17.9), whereas obesity was associated with NIV success (odds ratio, 0.22; 95% confidence interval, 0.05-0.91). Reintubation was required in half of the NIV-treated patients and was associated with an increased hospital mortality rate. Early respiratory failure after extubation (≤24 hours) is a predictive factor for NIV failure.

Noninvasive ventilation in a tertiary pediatric intensive care unit in a middle-income country

To determine the factors that predict outcome of noninvasive ventilation (NIV) in critically ill children. Prospective observational study. Multidisciplinary pediatric intensive care unit of a university hospital in Malaysia. Patients admitted to the pediatric intensive care unit from July 2004 to December 2006 for respiratory support due to acute respiratory failure and those extubated from invasive mechanical ventilation. NIV was used as an alternative means of respiratory support for all children. In patients who had prior invasive mechanical ventilation, NIV was used to facilitate extubation, or it was used after a failed extubation. The children were assigned to the nonresponders group (intubation was needed) or responders group (intubation was avoided totally or for at least 5 days). The physiologic variables were monitored before, at 6 hrs, and 24 hrs of NIV. Of 278 patients, 129 were admissions for management of acute respiratory failure and 149 patients received NIV to facilitate extubation (n = 98) or for a failed extubation (n = 48). Their median age and weight were 8.7 months (interquartile range, 3.1-33.1 months) and 5.5 kg (interquartile range, 3.3-10.8 kg), respectively. Intubation was avoided for > 5 days in 79.1% (n = 220). No significant difference in age or weight of responders and nonresponders was observed. The cardiorespiratory variables in all patients improved, but significant differences between the two groups were noted at 6 hrs and 24 hrs after NIV. NIV was a feasible strategy of respiratory support to avoid intubation in > 75% of children in this study. A higher Pediatric Risk of Mortality II score, sepsis at initiation of NIV, an abnormal respiratory rate, and a higher requirement of Fio2 may be predictive factors of NIV failure.

Factors associated with noninvasive ventilation failure in postoperative acute respiratory insufficiency: an observational study

Few data are available on the efficacy of noninvasive ventilation (NIV) in postoperative patients with acute respiratory failure (ARF). Seventy-two patients coming from the surgical wards with postoperative ARF were retrospectively evaluated. The major characteristics of patients who were intubated were compared with the characteristics of those who were not after a trial of NIV. Predictive factors for failure of NIV were analysed. Out of 72 patients with ARF after surgery who were treated with NIV, 42 avoided intubation (58%). On a univariate analysis, a decrease in the paO2/FiO2 ratio after 1 h of NIV (223 +/- 84 to 160 +/- 68 mmHg, P < 0.05) was associated with NIV failure and need for tracheal intubation because of nosocomial pneumonia and an increased simplified acute physiology score (SAPS) 2. In a multivariate analysis, nosocomial pneumonia [odds ratio (OR) 4.189; 95% confidence interval (CI) 1.383-12.687] and SAPS 2 higher than 35 (OR 4.969; 95% CI 1.627-15.172) were independent predictive factors of NIV failure. NIV success was associated with a reduced ICU stay (16.8 vs. 26.1 days, P < 0.001). NIV could be considered in postoperative patients who presented with ARF. Nosocomial pneumonia is predictive of NIV failure.

Noninvasive ventilation for acute respiratory failure after lung resection: an observational study

A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome. We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation. Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P < 0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5; 95% confidence interval, 1.9-68.3; P = 0.007) and no initial response to NIV (odds ratio, 117.6; 95% confidence interval, 10.6-1305.8; P = 0.0001). This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection.