Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies

Özyılmaz, Ezgi; Uğurlu, Aylin Özsancak; Nava, Stefano

doi:10.1186/1471-2466-14-19

Cited by 211 publications

(191 citation statements)

References 74 publications

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“…[1][2][3][4] However, some patients fail to see an improvement in their acute respiratory failure because of NIV failure, and are intubated. Previous studies have reported that NIV intolerance is one of the causes for intubation, [5][6][7][8][9][10][11] and one of the studies 8 has shown that poor NIV tolerance is associated with higher intubation rates. According to Antonelli et al, 7 NIV intolerance accounted for 25% of all intubations in subjects with ARDS.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

et al. 2015

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BACKGROUND: Noninvasive ventilation (NIV) intolerance is one reason for NIV failure. However, the characteristics, predictors, and outcomes of NIV intolerance are unclear. METHODS: A prospective observational study was performed in the respiratory intensive care unit of a teaching hospital. Subjects with acute respiratory failure who used NIV were enrolled. Initially, continuous use of NIV was encouraged. However, if the subject could not tolerate NIV, it was used intermittently. NIV intolerance was defined as termination of NIV due to subject refusal to receive it because of discomfort, even after intermittent use was attempted. RESULTS: A total of 961 subjects were enrolled in the study. Of these, 50 subjects (5.2%) experienced NIV intolerance after a median 2.4 h of NIV support. Age (OR ‫؍‬ 0.98, 95% CI 0.963-0.996) and heart rate (OR ‫؍‬ 1.02, 95% CI 1.006 -1.030) measured before NIV were 2 independent risk factors of NIV intolerance. After 1-2 h of NIV, independent risk factors of NIV intolerance were heart rate (OR ‫؍‬ 1.03, 95% CI 1.016 -1.044) and breathing frequency (OR ‫؍‬ 1.06, 95% CI 1.027-1.099). Intolerant subjects had no improvement in mean arterial pressure, heart rate, or breathing frequency after the NIV intervention. Moreover, intolerant subjects had a higher intubation rate (44.0% vs 25.8%, P ‫؍‬ .008) and higher mortality (34.0% vs 22.4%, P ‫؍‬ .08). The three most common complaints were that NIV worsened subjects' distress (46%), that NIV resulted in dyspnea (26%), and that the flow or pressure of NIV was too strong to bear (16%). CONCLUSIONS: NIV intolerance worsened subjects' outcomes. Younger subjects with a high heart rate and breathing frequency may be more likely to experience NIV intolerance.

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Section: Introductionmentioning

confidence: 99%

Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

et al. 2015

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“…Nearly 65% of NIV failures occur within the first 48 hours of NIV use [9][10][11]. This time interval has received more attention in assessments of NIV failure than any other.…”

Section: Early Niv Failurementioning

confidence: 99%

“…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 (OHS) and weaning from invasive mechanical ventilation) [6]. Since NIV can have failure rates ranging from 5% to 50%, NIV failure may cause intubation delay, increasing morbidity and mortality [11,12].…”

Section: Late Niv Failurementioning

confidence: 99%

Predictors of Noninvasive Ventilation Failure in Critically Ill Obese Patients: A Brief Narrative Review

Nicolini¹,

Lemyze

Esquinas

et al. 2017

Advances in Respiratory Medicine

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Non-invasive ventilation ( NIV ) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades than previously. Unfortunately, NIV can have failure rates ranging from 5% to 50% and patient selection is the key to success. There are particular groups of patients that are more likely to benefit from NIV. For patients with hypoventilation syndrome (OHS) this treatment can be beneficial. This review seeks to evaluate the effectiveness of NIV in acute ARF and determine predictors of NIV failure in morbidly obese patients. Only a few studies have investigated NIV success or failure in these patients. NIV was most often effective when patients were carefully selected. Obese patients who exhibited early NIV failure had a high severity score at admission. In contrast, more than half of hypercapnic patients with decompensated OHS exhibited a delayed but successful response to NIV. Patients with decompensation of OHS had better prognosis and response to NIV than other hypercapnic patients. They required more aggressive NIV settings, a longer time to reduce paCO 2 levels, and more frequently a delayed but successful response to NIV which should encourage the use of NIV rather than early intubation. Since clear predictors of NIV failure have not been identified, a strict and prolonged monitoring is mandatory.

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“…There were bilateral infiltrates compatible with acute respiratory distress syndrome (ARDS) at the same rate, and the use of NIMV in ARDS patients is unclear and controversial. It is indicated that pneumonia is a risk factor for the failure of NIMV (33,34).…”

Section: High Flow Nasal Oxygen Therapy In Different Clinical Situatimentioning

confidence: 99%

High Flow Nasal Oxygen Therapy: From Physiology to Clinic

Yıldırım¹,

Öcal²,

Ersoy³

et al. 2017

Eurasian J Pulmonol

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INTRODUCTIONOxygen support therapy should be given to the patients with acute hypoxic respiratory insufficiency in order to provide oxygenation of the tissues until the underlying pathology improves. The inspiratory flow rate requirement of patients with respiratory insufficiency varies between 30 and 120 L/min. Low flow and high flow conventional oxygen support systems produce a maximum flow rate of 15 L/min, and FiO 2 changes depending on the patient's peak inspiratory flow rate, respiratory pattern, the mask that is used, or the characteristics of the cannula. The inability to provide adequate airflow leads to discomfort in tachypneic patients. With high-flow nasal oxygen (HFNO) cannulas, warmed and humidified air matching the body temperature can be regulated at flow rates of 5-60 L/min, and oxygen delivery varies between 21% and 100%. When HFNO, first used in infants, was reported to increase the risk of infection, its long-term use was stopped. This problem was later eliminated with the use of sterile water, and its use has become a current issue in critical adult patients as well. Studies show that HFNO treatment improves physiological parameters when compared to conventional oxygen systems. Although there are studies indicating successful applications in different patient groups, there are also studies indicating that it does not create any difference in clinical parameters, but patient comfort is better in HFNO when compared with standard oxygen therapy and noninvasive mechanical ventilation (NIMV) (1-6). In this compilation, the physiological effect mechanisms of HFNO treatment and its use in various clinical situations are discussed in the light of current studies. The Impact Mechanisms of High Flow Nasal Oxygen TherapyThe HFNO device consists of an air/oxygen mixer, an active heater, a humidifier, a unidirectional inspiratory circuit hose, and a soft nasal cannula that is slightly larger than the standard nasal cannula. AbstractHigh-flow nasal oxygen (HFNO) therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNO in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNO for critical patients. This review summarizes the positive physiological effects, mechanisms of action, and the clinical applications of HFNO with available published literatures.

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Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies

Cited by 211 publications

References 74 publications

Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

Predictors of Noninvasive Ventilation Failure in Critically Ill Obese Patients: A Brief Narrative Review

High Flow Nasal Oxygen Therapy: From Physiology to Clinic

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