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Research ArticleOriginal Research

Incidence, Predictors, and Outcomes of Failure of Noninvasive Ventilation in Acute Heart Failure Hospitalization

Thomas S Metkus, P Elliott Miller, R Scott Stephens, Steven P Schulman and Shaker M Eid
Respiratory Care October 2020, 65 (10) 1527-1533; DOI: https://doi.org/10.4187/respcare.07661
Thomas S Metkus
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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  • For correspondence: [email protected]
P Elliott Miller
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
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R Scott Stephens
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Steven P Schulman
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Shaker M Eid
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Abstract

BACKGROUND: Some patients with acute heart failure (AHF) who are treated initially with noninvasive ventilation (NIV) will require endotracheal intubation, which indicates NIV failure. The incidence and prognosis of NIV failure in patients with AHF are not well characterized. METHODS: Using the National In-Patient Sample (NIS), we conducted a retrospective cohort study of subjects hospitalized with AHF between 2008 and 2014 who were treated with NIV within 24 h of hospital admission. We determined predictors of NIV failure and determined the association between NIV failure and in-hospital mortality using Cox proportional hazard models. RESULTS: Of 279,534 subjects hospitalized with AHF and treated with NIV, 4,257 (1.52%) failed NIV and required intubation. Cardiogenic shock (odds ratio 8.79, 95% CI 6.89–11.2) and in-hospital arrest (odds ratio 24.9, 95% CI 18.71–33.14) were associated with NIV failure. In-hospital mortality was 26.5% for NIV failure compared to 5.6% for those without NIV (P < .001). After adjustment for demographics, comorbidities, cardiogenic shock, and in-hospital arrest, NIV failure was associated with nearly a 2-fold risk of in-hospital mortality (odds ratio 1.95, 95% CI 1.59–2.40). CONCLUSIONS: Intubation after initial NIV treatment was required in 1.5% of subjects hospitalized with AHF and treated with NIV, and was associated with high in-hospital mortality. These findings can guide future prospective interventional trials and quality improvement ventures.

  • acute heart failure
  • respiratory failure
  • noninvasive ventilation
  • intubation

Footnotes

  • Correspondence: Thomas S Metkus MD, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Blalock 524, D2, 600 N Wolfe St, Baltimore, MD, 21287. E-mail: tmetkus1{at}jhmi.edu
  • Dr Metkus has disclosed relationships with BestDoctors, Oakstone/EBIX, and McGraw-Hill Publishing. The other authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (10)
Respiratory Care
Vol. 65, Issue 10
1 Oct 2020
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Incidence, Predictors, and Outcomes of Failure of Noninvasive Ventilation in Acute Heart Failure Hospitalization
Thomas S Metkus, P Elliott Miller, R Scott Stephens, Steven P Schulman, Shaker M Eid
Respiratory Care Oct 2020, 65 (10) 1527-1533; DOI: 10.4187/respcare.07661

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Incidence, Predictors, and Outcomes of Failure of Noninvasive Ventilation in Acute Heart Failure Hospitalization
Thomas S Metkus, P Elliott Miller, R Scott Stephens, Steven P Schulman, Shaker M Eid
Respiratory Care Oct 2020, 65 (10) 1527-1533; DOI: 10.4187/respcare.07661
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Keywords

  • acute heart failure
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