Risk factors for noninvasive ventilation failure in patients with acute cardiogenic pulmonary edema: A prospective, observational cohort study

Luo, Zujin; Han, Fang; Li, Yichong; He, Hangyong; Yang, Gen; Mi, Yuhong; Ma, Yingmin; Cao, Zhixin

doi:10.1016/j.jcrc.2017.01.001

Cited by 14 publications

(6 citation statements)

References 52 publications

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“…In their cohort, only 23.7% (71/300) were HSCT patients, while patients included in our study were all after HSCT. In a previous study of various populations, 15,16,18 rate of NIV failure varied from 37% to 54%. It is clear that HSCT patients have a higher rate of NIV failure after ARDS.…”

Section: Discussionmentioning

confidence: 96%

Risk factors of non-invasive ventilation failure in hematopoietic stem-cell transplantation patients with acute respiratory distress syndrome

Shen

Zhao

et al. 2020

Ther Adv Respir Dis

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Background: Non-invasive ventilation (NIV) was one of the first-line ventilation supports for hematopoietic stem-cell transplantation (HSCT) patients with acute respiratory distress syndrome (ARDS). Successful NIV may avoid need for intubation. However, the influence NIV failure had on patients’ outcome and its risk factors were hardly known. Methods: In this retrospective observational study, we reported risk factors and incidence of NIV failure in HSCT patients who were admitted to the Intensive Care Unit (ICU) with a diagnosis of ARDS and supported with mechanical ventilation, in a 5-year period. Patient outcomes, such as ventilator-free days, ICU-free days, and ICU mortality were also reported. Results: Of all the 94 patients included, 70 patients were initially supported with NIV. NIV failure occurred in 44 (63%) patients. Male sex, elevated serum galactomannan (GM) test, (1-3)- β- D-glucan (BG) assay, or elevated serum creatinine level were risk factors for NIV failure. When compared with the NIV success group, failure of NIV was associated with much fewer ICU-free days (22 versus 0, p < 0.001, Cohen’s d = 0.62) and higher ICU mortality (9.5% versus 75.5%, p < 0.001, Pearson’s r = 0.75). There was no difference in ICU-free days, ventilator-free days and ICU mortality between NIV failure and initial invasive mechanical ventilation (IMV) groups. Patients who failed in NIV support had a higher ICU mortality (75.5%) than those who succeeded (9.5%). Conclusion: In a small cohort of HSCT patients with mainly moderate severity of ARDS, male patients with elevated serum GM/BG test or serum creatinine level had a higher risk of NIV failure. Both NIV failure and initial IMV groups were characterized by high mortality rate and extremely low ICU-free days and ventilator-free days; failure of NIV support may further aggravate patient prognosis. The reviews of this paper are available via the supplemental material section.

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Section: Discussionmentioning

confidence: 96%

Risk factors of non-invasive ventilation failure in hematopoietic stem-cell transplantation patients with acute respiratory distress syndrome

Shen

Zhao

et al. 2020

Ther Adv Respir Dis

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“…Among 101 patients, 50 of them failed NIV, with failure incidence of 49.5%, which was higher than the 37.3% (44/118) in patients with acute cardiogenic pulmonary edema [ 21 ], the 17.1% (13/76) in patients with obesity [ 22 ], and the 38.4% (43/112) in patients with ARF after cardiac surgery, respectively [ 23 ]. This discrepancy of failure incidence may be associated with different etiologies and other factors [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Liu

et al. 2020

Canadian Respiratory Journal

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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.

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“…We report that worsening cardiac disease, in the form of cardiogenic shock and cardiac arrest, are associated with NIV failure. Shock, 29 more severe heart failure, 7,9 multisystem organ failure defined by Sequential Organ Failure Assessment (SOFA) score, 22 frailty, 30 poor mental status, 8 weak cough, 31 and higher tidal volume on NIV 29 are factors that have been reported in the literature to be associated with NIV failure. Similar to our findings, Liu and colleagues 18 also reported that older age was associated with lower risk of NIV intolerance.…”

Section: Factors Associated With Niv Failure In Ahfmentioning

confidence: 99%

“…Failure of NIV has been associated with excess mortality for patients with AHF, 2 yet further data are needed to clarify the magnitude of effect, which is important for prognostication and to guide intervention studies. The incidence of NIV failure in patients with AHF has been variable in prior studies, [3][4][5][6][7][8][9][10][11] and the lack of a comprehensive understanding of the incidence of NIV failure in patients with AHF represents a knowledge gap that is important for ICU triage and ICU and cardiac ICU staffing. [12][13][14][15] Finally, understanding the risk factors for NIV failure in patients with AHF is important to guide clinicians' choice of respiratory support modality.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15] Finally, understanding the risk factors for NIV failure in patients with AHF is important to guide clinicians' choice of respiratory support modality. 9,[16][17][18][19][20][21][22] To address these knowledge gaps, we conducted a nationwide cohort study of patients with AHF supported with NIV to determine the incidence and predictors of NIV failure and to characterize the magnitude of the association of NIV failure with mortality. We hypothesized that NIV failure would be associated with cardiogenic shock and noncardiac comorbidities and with excess mortality.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, Predictors, and Outcomes of Failure of Noninvasive Ventilation in Acute Heart Failure Hospitalization

et al. 2020

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BACKGROUND: Some patients with acute heart failure (AHF) who are treated initially with noninvasive ventilation (NIV) will require endotracheal intubation, which indicates NIV failure. The incidence and prognosis of NIV failure in patients with AHF are not well characterized. METHODS: Using the National In-Patient Sample (NIS), we conducted a retrospective cohort study of subjects hospitalized with AHF between 2008 and 2014 who were treated with NIV within 24 h of hospital admission. We determined predictors of NIV failure and determined the association between NIV failure and in-hospital mortality using Cox proportional hazard models. RESULTS: Of 279,534 subjects hospitalized with AHF and treated with NIV, 4,257 (1.52%) failed NIV and required intubation. Cardiogenic shock (odds ratio 8.79, 95% CI 6.89-11.2) and in-hospital arrest (odds ratio 24.9, 95% CI 18.71-33.14) were associated with NIV failure. In-hospital mortality was 26.5% for NIV failure compared to 5.6% for those without NIV (P < .001). After adjustment for demographics, comorbidities, cardiogenic shock, and in-hospital arrest, NIV failure was associated with nearly a 2-fold risk of inhospital mortality (odds ratio 1.95, 95% CI 1.59-2.40). CONCLUSIONS: Intubation after initial NIV treatment was required in 1.5% of subjects hospitalized with AHF and treated with NIV, and was associated with high in-hospital mortality. These findings can guide future prospective interventional trials and quality improvement ventures.

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Risk factors for noninvasive ventilation failure in patients with acute cardiogenic pulmonary edema: A prospective, observational cohort study

Cited by 14 publications

References 52 publications

Risk factors of non-invasive ventilation failure in hematopoietic stem-cell transplantation patients with acute respiratory distress syndrome

Risk factors of non-invasive ventilation failure in hematopoietic stem-cell transplantation patients with acute respiratory distress syndrome

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

Incidence, Predictors, and Outcomes of Failure of Noninvasive Ventilation in Acute Heart Failure Hospitalization

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