Predictive Factors for Failure of Noninvasive Ventilation in Adult Intensive Care Unit: A Retrospective Clinical Study

Abstract

Background. Noninvasive ventilation (NIV) has been reported to be beneficial for patients with acute respiratory failure in intensive care unit (ICU); however, factors that influence the clinical outcome of NIV were unclarified. We aim to determine the factors that predict the failure of NIV in critically ill patients with acute respiratory failure (ARF). Setting. Adult mixed ICU in a medical university affiliated hospital. Patients and Methods. A retrospective clinical study using data from critical adult patients with initial NIV admitted to ICU in the period August 2016 to November 2017. Failure of NIV was regarded as patients needing invasive ventilation. Logistic regression was employed to determine the risk factor(s) for NIV, and a predictive model for NIV outcome was set up using risk factors. Results. Of 101 included patients, 50 were unsuccessful. Although more than 20 variables were associated with NIV failure, multivariate logistic regression demonstrated that only ideal body weight (IBW) (OR 1.110 (95%1.027–1.201), P=0.009), the maximal heart rate during NIV period (HR-MAX) (OR 1.024 (1.004–1.046), P=0.021), the minimal respiratory rate during NIV period (RR-MIN) (OR 1.198(1.051–1.365), P=0.007), and the highest body temperature during NIV period (T-MAX) (OR 1.838(1.038–3.252), P=0.037) were independent risk factors for NIV failure. We set up a predictive model based on these independent risk factors, whose area under the receiver operating characteristic curve (AUROC) was 0.783 (95% CI: 0.676–0.899, P<0.001), and the sensitivity and specificity of model were 68.75% and 71.43%, respectively, with the optimal cut-off value of 0.4863. Conclusion. IBW, HR-MAX, RR-MIN, and T-MAX were associated with NIV failure in patients with ARF. A predictive model based on the risk factors could help to discriminate patients who are vulnerable to NIV failure.

The role of ultrasound in predicting non-invasive ventilation outcomes: a systematic review

“…Predicting NIV failure remains a diagnostic dilemma in general practice. Recent literature shows that patients presenting with acute respiratory failure have an NIV failure rate around 31-50% with nearly 65% of NIV failures occurring within 1-48 h of NIV use (8,(42)(43)(44). Current methods of evaluating for impending NIV failure is based on a multitude of parameters, of which some include monitoring vital signs, evaluating for signs of respiratory distress on physical examination, obtaining arterial blood gas values, calculating severity scores (e.g., SOFA, APACHE II, etc.…”

P/F Ratio is a Better Predictor for Non-Invasive Ventilation Failure and Length of Stay in Patients with Community-Acquired Pneumonia

“…The P/F ratio showed a negative correlation coefficient (r = −0.049), which implies that a better P/F ratio might contribute to survival or improvement in clinical conditions during hospitalization. A study performed by the French Intensive Care Society (Société de Réanimation de Langue Française/SRLF) Trial Group (2018) compared the length of ICU stay of hypoxemic patients (P/F ratio less than or equal to 300 mmHg) with non-hypoxemic patients and found that the median length of ICU stays in the hypoxemic group was approximately twice as long (16 [7-32] vs. 8 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] days, p < 0.001). 24 According to Mammadova, et al (2022), measuring the initial ROX index in patients admitted to the ICU was also helpful in predicting the length of ICU treatment, and the presence of respiratory failure and hypercapnia influenced its cut-off value.…”

“…2 NIV notably decreases the need for *Corresponding author: oh.liviaroxanne@gmail.com D ORIGINAL ARTICLE intubation and the death rate in patients with pneumoniaassociated respiratory failure in intensive care units (ICUs). 3 NIV failure indicates the need for intubation or mortality. The need for intubation following NIV is associated with elevated heart rate and respiratory rate, a decline in the Glasgow Coma Scale, decreased tissue oxygenation, lower blood pH, longer ICU stay, and higher in-hospital mortality.…”

“…The need for intubation following NIV is associated with elevated heart rate and respiratory rate, a decline in the Glasgow Coma Scale, decreased tissue oxygenation, lower blood pH, longer ICU stay, and higher in-hospital mortality. 3,4 Consequently, identifying patients who are at risk for NIV failure is crucial.…”

HACOR score to predict failure of non-invasive ventilation in patients with acute hypoxemic respiratory failure: When simplicity is best

“…Although NIV reduces work of breathing and avoids intubation in many patients, the rate of failure of NIV is very high (25-49%). [ 1 ]…”