RT Journal Article
SR Electronic
T1 Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure: Intubation Rate in an Experienced Unit
JF Respiratory Care
FD American Association for Respiratory Care
SP 2045
OP 2052
DO 10.4187/respcare.02456
VO 58
IS 12
A1 Damien Contou
A1 Chiara Fragnoli
A1 Ana Córdoba-Izquierdo
A1 Florence Boissier
A1 Christian Brun-Buisson
A1 Arnaud W Thille
YR 2013
UL http://rc.rcjournal.com/content/58/12/2045.abstract
AB BACKGROUND: Failure of noninvasive ventilation (NIV) is common in patients with COPD admitted to the ICU for acute hypercapnic respiratory failure (AHRF). We aimed to assess the rate of NIV failure and to identify early predictors of intubation under NIV in patients admitted for AHRF of all origins in an experienced unit. METHODS: This was an observational cohort study using data prospectively collected over a 3-year period after the implementation of a nurse-driven NIV protocol in a 24-bed medical ICU of a French university hospital. RESULTS: Among 242 subjects receiving NIV for AHRF (PaCO2 > 45 mm Hg), 67 had cardiogenic pulmonary edema (CPE), 146 had acute-on-chronic respiratory failure (AOCRF) (including 99 subjects with COPD and 47 with other chronic respiratory diseases), and 29 had non-AOCRF (mostly pneumonia). Overall, the rates of intubation and ICU mortality were respectively 15% and 5%. The intubation rates were 4% in CPE, 15% in AOCRF, and 38% in non-AOCRF (P < .001). After adjustment, non-AOCRF was independently associated with NIV failure, as well as acidosis (pH < 7.30) and severe hypoxemia (PaO2/FIO2 ≤ 200 mm Hg) after 1 hour of NIV initiation, whereas altered consciousness on admission and ventilatory settings had no influence on outcome. CONCLUSIONS: With a nurse-driven NIV protocol, the intubation rate was reduced to 15% in patients receiving NIV for AHRF, with a mortality rate of only 5%. Whereas the risk of NIV failure is associated with hypoxemia and acidosis after initiation of NIV, it is also markedly influenced by the presence or absence of an underlying chronic respiratory disease.