To identify factors contributing to failure of non-invasive ventilation (NIV) in patients with acute respiratory failure.
Univariate analysis was applied to a database of acute respiratory failure patients identified prospectively from eight medical centers throughout Massachusetts over a period of two years. NIV failure was defined as need for intubation.
Of 943 patients with acute respiratory failure enrolled in the study, 373 (40%) received NIV and 570 (60%) invasive mechanical ventilation. Of the NIV patients, 79 (21%) failed and required subsequent intubation. Risk factors significantly associated with NIV failure by univariate analysis included transfer from an outside acute care hospital, location in an ICU at initiation of therapy, diagnoses of pneumonia or sepsis, lack of hypercarbia, respiratory rate greater than 24 BPM, age less than 70 or diastolic BP less than 70 mmHg.
A number of readily available variables predict NIV failure and may be useful to identify patients in acute respiratory failure who, if begun on NIV, should be closely monitored in an ICU.
The ability to identify patients at high risk for NIV failure may lead to more appropriate utilization and closer monitoring of NIV and, thereby, enhanced NIV success rates.
Samy Sidhom, Grant monies (from sources other than industry) CHEST Foundation; Grant monies (from industry related sources) Respironics; No Product/Research Disclosure Information