PURPOSE: Noinvasive ventilation (NIV) has shown to be usefull in COPD patient with severe exacerbation NIV usefulness is more controversial in severe hypoxemic ARF like adult respiratory distress syndrome (ARDS).
METHODS: Prospective observational study, with all the patients admitted to ICU with ARDS, between 1997 to 2005. Indication for NIV was dypsnea, respiratory rate (RR) >30 bpm, PaO2/FiO2 <200, pHa <7.35 or accessory respiratory muscle activity. Primary study goal was to determinate the success of NPPV (defined as a response to therapy, avoiding endotracheal intubation, and surviving during the stay in ICU and at least 24 h on a medical ward). Secondary study goal was to identify variables that can predict a failure of NPPV and hospital mortality.
RESULTS: We have studied 236 patients, age was 58±20 años, SAPS II: 47±15 and 61% male. COPD antecedents:13.6% and shock at NIV start: 39.4%. They had received NIV in BiPAP mode: 94.1%. Main ARDS ethiology is extrapulmonary, in 62.7%. Respiratory parameters at the begining and one hour after NIV therapy were: PaO2/FiO2: 131±31 and 155±36 (p<0.001), PaCO2:42±15 and 41±14 (p:0.230), pHa:7.35±0.1 and 7.35±0.08 (p:0.612) and RR: 36±5 and 33±5 (p<0.001). NIV sucess was seen in 64 patients (27.1%). Hospital stay and mortality were: 26±23 days and 55.9%. Variables asociated to NIV failure were:RR 1 hour-NIV (OR: 1.25, 95% CI: 1.13 to 1.37), Post-surgery (OR:2.70, 95% CI: 1.02 to 7.10), PaO2/FiO2 1hour-NIV (OR:0.97, 95% CI: 0.96 to 0.98), Age (OR:1.25, 95% CI:1.13 to 1.37) and SOFA maximun (OR:1.18, 95% CI: 1.05 to 1.33). Variables related with hospital mortality were:Age (OR:1.04, 95% CI:1.02 to 1.06), SOFA maximun (OR: 1.50, 95% CI: 1.34 to 1.68) and Inmunosupressed (OR: 7.08, 95% CI: 2.53 to 19.82.
CONCLUSION: NIV sucess in ARDS patients is low. If we decide to treat ARDS patients, we have to select them in a very rigorous way.
CLINICAL IMPLICATIONS: NIV is not useful in ARDS patients. Anyway, we could try a session with NIV therapy only in selected pacients without multiorgan failure.
DISCLOSURE: Antonio Esquinas, None.