Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Background

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.

Method

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.

Results

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).

Conclusion

This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kutlu CA, Williams EA, Evans TW, Pastorino U, Goldstaw P (2000) Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 69:376–380

    Article  PubMed  CAS  Google Scholar 

  2. Aguilo R, Togores B, Pons S, Rubi M, Barbe F, Agusti AGN (1997) Noninvasive ventilatory support after lung resectional surgery. Chest 112:117–121

    Article  PubMed  CAS  Google Scholar 

  3. Auriant I, Jallot A, Hervé P, Cerrina J, Leroy Ladurie F, Fournier JL, Lescot B, Parquin F (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164:1231–1235

    PubMed  CAS  Google Scholar 

  4. Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251

    Article  PubMed  CAS  Google Scholar 

  5. Yano T, Yokoyama H, Fukuyama Y, Takai E, Mizutani K, Ichinose Y (1997) The current status of postoperative complications and risk factors after a pulmonary resection for primary lung cancer: a multivariate analysis. Eur J Cardiothorac Surg 11:445–449

    Article  PubMed  CAS  Google Scholar 

  6. Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T, Oyama T, Osaki T, Yasumoto K (2001) Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer. Thorax 56:59–61

    Article  PubMed  CAS  Google Scholar 

  7. Algar FJ, Alvarez A, Salvatierra A, Baamonde C, Aranda JL, Lopez-Pujol FJ (2003) Predicting pulmonary complications after pneumonectomy for lung cancer. Eur J Cardiothorac Surg 23:201–208

    Article  PubMed  Google Scholar 

  8. Schussler O, Alifano M, Dermine H, Strano S, Casetta A, Sepulveda S, Chafik A, Coignard S, Rabbat A, Regnard JF (2006) Postoperative pneumonia after major lung resection. Am J Respir Crit Care Med 173:1161–1169

    Article  PubMed  Google Scholar 

  9. Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelli B, Bonnet F (2000) Pulmonary complications following lung resection : a comprehensive analysis of incidence and possible risk factors. Chest 118:1263–1270

    Article  PubMed  CAS  Google Scholar 

  10. Demoule A, Girou E, Richard JC, Taillé S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755

    Article  PubMed  Google Scholar 

  11. Girault C, Briel A, Hellot MF, Tamion F, Woinet D, Leroy J, Bonmarchand G (2003) Noninvasive mechanical ventilation in clinical practice: a 2-year experience in a medical intensive care unit. Crit Care Med 31:552–559

    Article  PubMed  Google Scholar 

  12. Brochard L, Mancebo J, Wysocky M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F, Isabey D, Harf A (1995) Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med 333:817–822

    Article  PubMed  CAS  Google Scholar 

  13. Wysocki M, Antonelli M (2001) Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure. Eur Respir J 18:209–220

    Article  PubMed  CAS  Google Scholar 

  14. Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444

    Article  PubMed  Google Scholar 

  15. Martin TJ, Hovis JD, Costantino JP, Bierman MI, Donahoe MP, Rogers RM, Kreit JW, Sciurba FC, Stiller RA, Sanders MH (2000) A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 161:807–813

    PubMed  CAS  Google Scholar 

  16. Plant PK, Owen JL, Elliott MW (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicenter randomised controlled trial. Lancet 355:1931–1935

    Article  PubMed  CAS  Google Scholar 

  17. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS (2003) Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: cochrane systematic review and meta-analysis. BMJ 326:185

    Article  PubMed  Google Scholar 

  18. Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Meduri UG (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585–1591

    PubMed  CAS  Google Scholar 

  19. Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti G, Guerin C, Schortgen F, Lefort Y, Antonelli M, Lepage E, Lemaire F, Brochard L (2000) Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA 284:2352–2360

    Article  PubMed  CAS  Google Scholar 

  20. Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, Epstein SK, Hill NS, Nava S, Soares MA, D’Empaire G, Alia I, Anzueto A (2004) Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 350:2452–2460

    Article  PubMed  CAS  Google Scholar 

  21. Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, Rodriguez-Roisin R, Torres A (2003) Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 168:70–76

    Article  PubMed  Google Scholar 

  22. Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, Pelaia P, Principi T, Gregoretti C, Beltrame F, Pennisi MA, Arcangeli A, Proietti R, Passariello M, Meduri GU (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728

    Article  PubMed  CAS  Google Scholar 

  23. Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880

    PubMed  CAS  Google Scholar 

  24. Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med 32:1756–1765

    Article  PubMed  Google Scholar 

  25. Duncan SR, Negrin RS, Mihm FG, Guilleminault C, Raffin TA (1987) Nasal continuous positive airway pressure in atelectasis. Chest 92:621–624

    Article  PubMed  CAS  Google Scholar 

  26. Jaber S, Gallix B, Sebbane M (2005) Noninvasive ventilation improves alveolar recruitment on postoperative patients with acute respiratory failure: a CT-scan study. Intensive Care Med 31:S148

    Article  Google Scholar 

  27. Perrin C, Jullien V, Venissac N, Berthier F, Padovani B, Guillot F, Coussement A, Mouroux J (2007) Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Respir Med 101:1572–1578

    Article  PubMed  Google Scholar 

  28. Nava S, Navalesi P, Conti G (2006) Time of non-invasive ventilation. Intensive Care Med 32:361–370

    Article  PubMed  Google Scholar 

  29. Nan DN, Fernandez-Ayala M, Farinas-Alvarez C, Mons R, Ortega FJ, Gonzalez-Macias J, Farinas MC (2005) Nosocomial infection after lung surgery: incidence and risk factors. Chest 128:2647–2652

    Article  PubMed  Google Scholar 

  30. Gilljam M, Chaparro C, Tullis E, Chan C, Keshavjee S, Hutcheon M (2003) GI complications after lung transplantation in patients with cystic fibrosis. Chest 123:37–41

    Article  PubMed  Google Scholar 

  31. Fraisse A, Brosse S, Manckoundia P, Popitean L, Pfitznemeyer P (2003) Ogilvie syndrome in the elderly: retrospective study in 40 cases. Presse Med 32:1500–1504

    PubMed  Google Scholar 

  32. Scala R, Bartolucci S, Naldi M, Rossi M, Elliott MW (2004) Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation. Intensive Care Med 30:1747–1754

    Article  PubMed  Google Scholar 

  33. Rabbat A, Chaoui D, Montani D, Legrand O, Lefebvre A, Rio B (2005) Prognosis of patients with acute myeloid leukemia admitted in intensive care. Br J Haematol 129:350–357

    Article  PubMed  Google Scholar 

  34. Carlucci A, Delmastro M, Rubini F, Fracchia C, Nava S (2003) Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years. Intensive Care Med 29:419–425

    PubMed  Google Scholar 

  35. Confalonieri M, Garuti G, Cattaruzza MS, Osborn JF, Antonelli M, Conti G, Kodric M, Resta O, Marchese S, Gregoretti C, Rossi A, Italian noninvasive positive pressure ventilation (NPPV) study group (2005) A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J 25:348–355

    Article  PubMed  CAS  Google Scholar 

  36. Meduri GU, Turner RE, Abou-Shala N, Wunderink R, Tolley E (1996) Noninvasive positive pressure ventilation via face mask. First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest 109:179–193

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest statement

None of the authors has any conflict of interest relevant to this study.

Author information

Authors and Affiliations

  1. Department of Respiratory and Intensive Care Medicine, Hôtel-Dieu Hospital, AP-HP, Université Paris 5, René Descartes, Paris, France

    Aurélie Lefebvre, Christine Lorut, Nicolas Roche, Gérard Huchon & Antoine Rabbat

  2. Department of Thoracic Surgery, Hôtel-Dieu Hospital, AP-HP, Université Paris 5, René Descartes, Paris, France

    Marco Alifano & Jean-François Regnard

  3. Department of Anesthesiology and Surgical Intensive Care, Hôtel-Dieu Hospital, AP-HP, Université Paris 5, René Descartes, Paris, France

    Hervé Dermine & Rémy Gauzit

  4. Pneumologie et Réanimation, Hôtel-Dieu, 1, place du parvis de Notre-Dame, 75181, Paris Cedex 04, France

    Antoine Rabbat

Authors
  1. Aurélie Lefebvre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Lorut
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Alifano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hervé Dermine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicolas Roche
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rémy Gauzit
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-François Regnard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gérard Huchon
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antoine Rabbat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antoine Rabbat.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary material (RTF 70 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lefebvre, A., Lorut, C., Alifano, M. et al. Noninvasive ventilation for acute respiratory failure after lung resection: an observational study. Intensive Care Med 35, 663–670 (2009). https://doi.org/10.1007/s00134-008-1317-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-008-1317-z

Keywords

Search

Navigation