Factors and Outcomes Associated with Failed Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure

Abstract

Ya-Ru Liang,1,2,* Chou-Chin Lan,1,3,* Wen-Lin Su,1,3 Mei-Chen Yang,1,3 Sin-Yi Chen,1 Yao-Kuang Wu1,3 1Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, TaoYuan City, Taiwan; 3School of Medicine, Tzu-Chi University, Hualien, Taiwan*These authors contributed equally to this workCorrespondence: Yao-Kuang Wu, Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Road, Xindian Dist, New Taipei City, Taiwan, Tel [phone] ext 5709, Fax [phone], Email [email protected]: The decision guild for non-invasive positive pressure ventilation (NPPV) application in acute respiratory failure (ARF) patients still needs to work out.Methods: Adult patients with acute hypoxemic or hypercapnic respiratory failure were recruited and treated with NPPV or primary invasive mechanical ventilation (IMV). Patients’ characteristic and clinical outcomes were recorded. Logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals for baseline characteristics and clinical outcomes. Subgroup analyses by reason behind successful NPPV were conducted to ascertain if any difference could influence the outcome.Results: A total of 4525 ARF patients were recruited in our facility between year 2015 and 2017. After exclusion, 844 IMV patients, 66 patients with failed NPPV, and 74 patients with successful NPPV were enrolled. Statistical analysis showed APACHE II score (aOR = 0.93), time between admission and start NPPV (aOR = 0.92), and P/F ratio (aOR = 1.04) were associated with successful NPPV. When comparing with IMV patients, failed NPPV patients displayed a significantly lower APACHE II score, higher Glasgow Coma Scale, longer length of stay in hospital, longer duration of invasive ventilation, RCW/Home ventilator, and some comorbidities.Conclusion: APACHE II score, time between admission and start NPPV, and PaO2 can be predictors for successful NPPV. The decision of NPPV application is critical as ARF patients with failed NPPV have various worse outcomes than patients receiving primary IMV.Keywords: acute respiratory failure, hospital stay, invasive mechanical ventilation, non-invasive positive pressure ventilation

Keywords

• acute respiratory failure
• hospital stay
• invasive mechanical ventilation
• non-invasive positive pressure ventilation