Should we perform noninvasive ventilation anywhere?

Ambrosino, Nicolino

doi:10.1586/ers.12.14

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…Addition of non-invasive ventilation (NIV) to this regimen in patients with acute hypercapnic respiratory failure has resulted in reduced rates of endotracheal intubation (ETI) and overall mortality [4]. The development of respiratory intermediate care units has expanded the use of NIV in COPD exacerbation outside ICU [5]. However, incorrect patient selection at admission or under-recognition of NIV failure leads to delay of ETI which subsequently is associated with increased mortality, with reported failure rates that vary between 9 and 50% [6].…”

Section: Introductionmentioning

confidence: 99%

Predictors of outcome of noninvasive ventilation in severe COPD exacerbation

et al. 2019

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Background Noninvasive ventilation (NIV) reduces the rate of endotracheal intubation (ETI) and overall mortality in severe acute exacerbation of COPD (AECOPD) with acute respiratory failure and is increasingly applied in respiratory intermediate care units. However, inadequate patient selection and incorrect management of NIV increase mortality. We aimed to identify factors that predict the outcome of NIV in AECOPD. Also, we looked for factors that influence ventilator settings and duration. Methods A prospective cohort study was undertaken in a respiratory intermediate care unit in an academic medical center between 2016 and 2017. Age, BMI, lung function, arterial pH and pCO2 at admission (t0), at 1–2 h (t1) and 4–6 h (t2) after admission, creatinine clearance, echocardiographic data (that defined left heart dysfunction), mean inspiratory pressure during the first 72 h (mIPAP-72 h) and hours of NIV during the first 72 h (dNIV-72 h) were recorded. Main outcome was NIV failure (i.e., ETI or in-hospital death). Secondary outcomes were in-hospital mortality, length of stay (LOS), duration of NIV (days), mIPAP-72 h, and dNIV-72 h. Results We included 89 patients (45 male, mean age 67.6 years) with AECOPD that required NIV. NIV failure was 12.4%, and in-hospital mortality was 11.2%. NIV failure was correlated with days of NIV, LOS, in-hospital mortality ( p < 0.01), and kidney dysfunction ( p < 0.05). In-hospital mortality was strongly associated with days of NIV (OR 1.27, 95%CI: 1.07–1.5, p < 0.01) and with FEV1 ( p < 0.05). All other investigated parameters (including left heart dysfunction, dNIV-72 h, mIPAP-72 h, pH, etc.) did not influence NIV failure or mortality. dNIV-72 h and days of NIV were independent predictors of LOS ( p < 0.01). Regarding the secondary outcomes, left heart dysfunction and pH at 1-2 h independently predicted NIV duration (dNIV-72 h, p < 0.01), while BMI and baseline pCO2 predicted NIV settings (mIPAP-72 h, p < 0.01). Conclusion In-hospital mortality and NIV failure were not influenced by BMI, left heart dysfunction, age, nor by arterial blood gas values in the first 6 h of NIV. Patients with severe acidosis and left heart dysfunction required prolonged use of NIV. BMI and pCO2 levels influence the NIV settings in AECOPD regardless of lung function.

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Section: Introductionmentioning

confidence: 99%

Predictors of outcome of noninvasive ventilation in severe COPD exacerbation

et al. 2019

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“…In clinical practice, NIV service location and protocols may vary according to local resources, particularly the availability of ICU beds. The question of where NIV should be delivered has been much debated in the literature . To our knowledge, no direct comparison of NIV models of care (general ward (Ward), HDU and ICU) has ever been undertaken.…”

Section: Introductionmentioning

confidence: 99%

“…The question of where NIV should be delivered has been much debated in the literature. [11][12][13] To our knowledge, no direct comparison of NIV models of care (general ward (Ward), HDU and ICU) has ever been undertaken. We hypothesised that a Ward-based NIV service would produce equivalent clinical outcomes compared with an HDU-or ICUbased model and be more cost-effective, when treating hypercapnic AECOPD.…”

Section: Introductionmentioning

confidence: 99%

Models of care for non‐invasive ventilation in the Acute COPD Comparison of three Tertiary hospitals (ACT3) study

et al. 2017

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“…Location of NIV treatment is an important predictor of NIV success which is associated with favorable outcomes of ARF [4,10,13]. The patient's severity of illness, need for monitoring and capabilities of the location to provide monitoring and skilled, experienced staff are important in deciding on the location of NIV application [13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%