Elsevier

Respiratory Medicine

Volume 103, Issue 1, January 2009, Pages 67-73
Respiratory Medicine

Impact of noninvasive ventilation (NIV) trial for various types of acute respiratory failure in the emergency department; decreased mortality and use of the ICU

https://doi.org/10.1016/j.rmed.2008.08.001Get rights and content
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Summary

Background

Trial of noninvasive ventilation (NIV) in the emergency department (ED) for heterogeneous acute respiratory failure (ARF) has been optional and its clinical benefit unclear.

Methods

We conducted a retrospective cohort study comparing between two periods, October 2001–September 2003 and October 2004–September 2006, i.e., before and after adopting an NIV-trial strategy in which NIV was applied in the ED to any noncontraindicated ARF patients needing ventilatory support and was then continued in the intermediate-care-unit. During these two periods, we retrieved cases of ARF treated either invasively or with NIV, and compared the patients' in-hospital mortalities and the length of ICU and intermediate-care-unit stay.

Results

Compared were 73 (invasive 56, NIV 17) and 125 cases (invasive 31, NIV 94) retrieved from 271 and 415 emergent admissions with proper pulmonary etiologies for mechanical ventilation, respectively. Of their respiratory failures, type (hypercapnic/non-hypercapnic, 0.97 vs. 0.98) and severity (pH 7.23 vs. 7.21 for hypercapnic; PaO2/FiO2 133 vs. 137 for non-hypercapnic) were similar, and the rate of predisposing etiologies was not significantly different. However, excluding those with recurrent aspiration pneumonia for whom NIV was mostly used as “ceiling” treatment, significant reductions in both overall in-hospital mortality (38%–19%, risk ratio 0.51, 95% CI 0.31–0.84), and median length of ICU and intermediate-care-unit stay (12 vs. 5 days, P < 0.0001) were found.

Conclusions

NIV-trial in the ED for all possible patients with ARF of pulmonary etiologies, excluding those with recurrent aspiration pneumonia, may reduce overall in-hospital mortality and ICU stays.

Keywords

Noninvasive Ventilation
Acute respiratory failure
Mortality
Intensive-care-unit
Emergency department

Abbreviations

ARF
acute respiratory failure
Bilevel-PAP
bilevel positive airway pressure
CPAP
continuous positive airway pressure
DNI
do-not-intubate
ED
emergency department
NIV
noninvasive ventilation
PEEP
positive end-expiratory pressure

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