Clinical Prediction Score for Successful Weaning from Noninvasive Positive Pressure Ventilation (NIPPV) in Emergency Department; a Retrospective Cohort Study

Abstract

Introduction: Due to the lack of in-hospital beds, some patients with acute cardiogenic pulmonary edema are initiated and weaned off noninvasive positive pressure ventilation (NIPPV) at the emergency department (ED). This study aimed to develop a clinical score to predict successful weaning from NIPPV in these patients. Methods: This retrospective cohort study was conducted on patients with acute cardiogenic pulmonary edema who received NIPPV at the ED of Ramathibodi Hospital, Bangkok, Thailand. Multivariable logistic regression analysis was used to developed a predictive model for weaning from NIPPV. Results: 355 patients with acute cardiogenic pulmonary edema treated with NIPPV were studied (107 (30.14%) failed to be weaned). The significant risk factors of weaning failure based on multivariate analysis were age > 75 years (OR: 3.1, 95% CI: 1.15–8.33, p = 0.025), pneumonia (OR: 2.72, 95% CI: 1.39–5.31, p = 0.003), pulse rate > 80 bpm before NIPPV (OR: 1.74, 95% CI: 1.04–2.91, p = 0.033), and a urinary output 26 breaths/min before weaning and oxygen saturation of 75, presence of pneumonia, heart rate > 80 bpm before weaning, and urinary output 5 points were in low, moderate, and severe risk of weaning failure, respectively.

Keywords

• Noninvasive Ventilation
• ventilator weaning
• continuous positive airway pressure
• emergency service, hospital
• intubation