NDLI: Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study

Content Provider	Springer Nature : BioMed Central
Author	Rana, Sameer Jenad, Hussam Gay, Peter C Buck, Curtis F Hubmayr, Rolf D Gajic, Ognjen
Abstract	Introduction The role of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute lung injury (ALI) is controversial. We sought to assess the outcome of ALI that was initially treated with NIPPV and to identify specific risk factors for NIPPV failure. Methods In this observational cohort study at the two intensive care units of a tertiary center, we identified consecutive patients with ALI who were initially treated with NIPPV. Data on demographics, APACHE III scores, degree of hypoxemia, ALI risk factors and NIPPV respiratory parameters were recorded. Univariate and multivariate regression analyses were performed to identify risk factors for NIPPV failure. Results Of 79 consecutive patients who met the inclusion criteria, 23 were excluded because of a do not resuscitate order and two did not give research authorization. Of the remaining 54 patients, 38 (70.3%) failed NIPPV, among them all 19 patients with shock. In a stepwise logistic regression restricted to patients without shock, metabolic acidosis (odds ratio 1.27, 95% confidence interval (CI) 1.03 to 0.07 per unit of base deficit) and severe hypoxemia (odds ratio 1.03, 95%CI 1.01 to 1.05 per unit decrease in ratio of arterial partial pressure of O2 and inspired O2 concentration – PaO2/FiO2) predicted NIPPV failure. In patients who failed NIPPV, the observed mortality was higher than APACHE predicted mortality (68% versus 39%, p < 0.01). Conclusion NIPPV should be tried very cautiously or not at all in patients with ALI who have shock, metabolic acidosis or profound hypoxemia.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc4923.pdf
Ending Page	5
Page Count	5
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc4923
Journal	Critical Care
Issue Number	3
Volume Number	10
Language	English
Publisher	BioMed Central
Publisher Date	2006-05-12
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Continuous Positive Airway Pressure Acute Lung Injury Metabolic Acidosis Invasive Mechanical Ventilation Severe Hypoxemia
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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