PURPOSE:in last years non invasive ventilation (NIV) reached an important role in Acute Respiratory Failure (ARF) also outside Intensive Care Units (ICU): improves clinical parameters and arterial gases, decrease mortality and intubation (ETI). Objective of the study: to determine applicability of NIV in a general non-respiratory medical-ward.
METHODS:50 consecutive Pts with Hypoxemic or Hypercapnic ARF: 22Pts(44%) ACPE, 18Pts(36%) AECOPD, 5(10%) Pneumonia, 5(10%) ALI/ARDS. Baseline characteristics: mean RR 36/min, mean neurological Kelly score 2.77, mean pH 7.22, mean PaCO2 70mmHg, mean PaO2 49 mmHg, mean age 83. In addition to conventional treatment Pts received:-ACPE: CPAP10cmH2O-COPD: PSV(10–15 cmH2O)+PEEP(4–6 cmH2O)+aerosol therapy with short-acting beta2agonists-ALI/ARDS, Pneumonia: CPAP or bi-level pressure ventilation.
RESULTS:Primary outcome: NIMV failure defined as “need for intubation” or “death”. Nine Pts (18%) failed: eight of these (16%) needed ETI (5 ALI/ARDS p<0.0001, 3COPD=failure rate 16.6%p=0.58): one Patient (2%) died (Pneumonia). No ACPE Pts failed (p=0.0027). Secondary outcomes:-Significant improvement (p<0.05) in RR, Kelly-Score, pH, PaCO2, PaO2 versus baseline data.-Median duration of treatment: 16:06hours with differences depending on aetiology: COPD Pts 18:54hours, ACPE 4:15, Pneumonia 20. -Mean length of hospitalisation of responder Pts: 8.66 days-No patients discontinued NIV for side effects.
CONCLUSION:Results of this study are consistent with literature's data. Failure rate of NIV (18%) is similar to those reported in studies performed in ICU, ED and Ward setting. Hypoxemic ARF related to ALI/ARDS and pneumonia show a worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. For the treatment of ARF due to AECOPD and ACPE NIV is feasible, safe and effective in a general medical-ward: improves clinical parameters, arterial blood gases values and can prevent ETI, ICU transfer and invasive-ventilation events related to high mortality rate, complications, longer hospitalisation.
CLINICAL IMPLICATIONS:These findings should encourage the diffusion of NIV in general medical-wards. According to strong evidences in literature, NIV should be considered a first-line and standard treatment in ACPE and AECOPD irrespective of the setting.
DISCLOSURE:Federico Lari, No Financial Disclosure Information; No Product/Research Disclosure Information