Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital

Abstract

OBJECTIVES:To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis.METHODS:A prospective cohort study.RESULTS:Medical disorders (59%) and elective surgery (21%) were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55%) and a decreased level of consciousness (20%). The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5) versus four (3-7) days]; they had lower levels of pH, HCO3 and base excess, and the FiO2 level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26) days vs. 8 (5-14) days], as well as a higher mortality rate (9 vs. 51%). There was an association between failure and mortality, which had an odds ratio (95% CI) of 10.6 (5.93 – 19.07). The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II≥34, an inspiratory positive airway pressure level≥15 cmH2O and pH<7.40.CONCLUSION:The indications for noninvasive positive-pressure ventilation were quite varied. The failure group had a longer intensive care unit stay and higher mortality. Simplified Acute Physiology Score II≥34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.

Use of noninvasive ventilation for acute respiratory failure in intensive care unit.

“…(17)(18)(19) The EI reasons noted by this research include the ARF and the decreased level of consciousness. Similar results were also found by Yamauchi et al (13) and Holland et al (10) , which emphasized these same points as the main causes of failure of NIV. Identification of predictive success or failure of NIV can both avoid unnecessary EI as to avoid a late EI and its complications.…”

“…In observational studies, Yamauchi et al (13) and Azevedo et al (7) found a significant relationship between the failure of NIV and lower levels of pH and worse prognosis, explicit through the longer length of stay in ICU and a higher mortality.…”

“…(11,12) During the study, subjects were divided into two groups according to their clinical evolution, namely: success group (SG), characterized by the non-EI after use of NIV, and failure group (FG), characterized by the EI by up to 72 hours after use of NIV. (13) The decision on the use of NIV and the EI fell to the multidisciplinary team studied unit. It is noteworthy that, in the studied hospital, there is no protocol implemented for such procedures.…”

Noninvasive positive pressure ventilation after extubation: features and outcomes in clinical practice

“…The use of noninvasive ventilation after planned extubation is part of clinical practice worldwide. ( 1 - 4 , 15 ) In a study by Carlucci et al, ( 16 ) the rate of NIPPV in 52 ICUs was 8%. In our hospital, we estimated almost twice that rate (15%).…”

Treatment of a Patient with NPPV Who Developed ARDS Caused by Community-Acquired Pneumonia: A Case Report

“…Yine Uzman merkezlerde, NPPV nin ARDS ye ilk etap tedavi olarak uygulanması sonucunda, tedavi edilen hastaların %54'ünde entübasyon uygulanmamıştır. Yalnızca SAPS II >34 çıkan ve 1 saatlik NPPV tedavisinden sonra PaO 2 /FiO 2 'si düzelmeyen hastalar entübasyona ihtiyacı var kabul edilmiş (9). Ayrıca akut solunum yetmezliği olan 64 hastada, NİPBV'nin invaziv MV kadar etkili olduğu ve NİPBV'nin uygulandığı hastaların YB'da kalış süresinin daha kısa ve ciddi komplikasyonların daha az olduğu belirtilmiştir (3).…”