Determinants of Noninvasive Ventilation Outcomes during an Episode of Acute Hypercapnic Respiratory Failure in Chronic Obstructive Pulmonary Disease: The Effects of Comorbidities and Causes of Respiratory Failure

Abstract

Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functional parameters were recorded including the cause of acute respiratory failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered failure. Results. NIV outcome was successful in 134 patients while 42 underwent failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status.

Oronasal mask versus helmet in acute hypercapnic respiratory failure

“…This calculation was based on expected baseline PaCO 2 values of 80 mmHg, according to the average admission value in our unit in the last 3 years [29]. Hypothesising 30% drop-out rate, it was therefore necessary to include 80 patients [15].…”

Effectiveness of non-invasive ventilation in acute respiratory failure of obese patients: a brief narrative review

“…[5][6][7]13,[17][18][19][20][21] Patients with OHS often respond well to NIV. The pathophysiology of OHS results from complex interactions between various sleep breathing disorders (obstructive sleep apnea, REM sleep hypoventilation), increased work of breathing due to a decreased thoraco-abdominal compliance, and altered ventilatory drive.…”

“…Over the past two decades, increasing evidence in literature has confirmed the main role of NIV in first line therapy for certain forms of acute respiratory failure (ARF), 4 particularly in ARF due to acute exacerbations of chronic obstructive pulmonary disease (COPD), and cardiogenic pulmonary. [5][6][7] Its usefulness has also been confirmed in patients who are immuno-compromised from hematological diseases. 7 Over the time NIV was used in more severe patients and several clinical situations with proven efficacy (e.g., restrictive lung diseases, obesity hypoventilation syndrome and weaning from invasive mechanical ventilation).…”

Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure

“…Our data have also confirmed the importance of a chart of failure risk described by Confalonieri et al 28 Patients with more severe illness, and particularly those in whom pH does not improve to 7.25 or higher within 2 hours after NIV, have a high risk of failure. 16,29,30 On the other hand, the probability of NIV success increases in relation to the appropriate choice of ventilator modality and interface, the level of team experience, the level of patient's understanding, and advanced age.…”

“…The presence of pneumonia has already been reported as a predictor of NIV failure, together with a lack of improvement of pH. 29,36 Second, the criteria of intubation were not standardized a priori, as for a randomized controlled trial, but each center followed its institutional guidelines (which reflects the "real-life" setting). Third, we only considered the presence or absence of comorbidities, without investigating their type or number in individual patients or their role in determining NIV failure.…”