Critical Care |

Evaluation of Deaths Related to Noninvasive Ventilation Failure FREE TO VIEW

Ginger Tsai-Nguyen, MD; Avery Smith, MD; Katharine Gaston; Pamela Hoof, MD; Adan Mora, MD
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Baylor University Medical Center, Dallas, TX

Chest. 2015;148(4_MeetingAbstracts):250A. doi:10.1378/chest.2242984
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SESSION TITLE: Critical Care Posters III

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Non-Invasive Ventilation (NIV) is a mainstay in respiratory failure. However, patients may fail this therapy progressing to invasive ventilation support and possibly death. The characteristics of these patients need to be identified.

METHODS: A chart review was performed at Baylor University Medical Center of 100 consecutive patients prescribed NIV in September 2014. A subset of 36 patients with a clear diagnosis of respiratory failure was further evaluated. Assessment of patient characteristics, duration of NIV, progression toinvasive ventilation and disposition were identified.

RESULTS: Of the patients analyzed, 78% were not intubated. Their average age was 76 years and 16% of them were not initially admitted to an intensive care unit (ICU). Their average time to NIV from admission was 9.5 hours with an NIV duration of 130 hrs. Underlying lung disease was noted in 33%, 83% had hypertension (HTN), 66% had cardiovascular (CV) disease, and none were diabetics. With regard to disposition, 50% were discharged home, 18% were discharged to a skilled nursing facility/rehab, 11% went to hospice (66% were Do Not Resuscitate (DNR)) and 21% died (83% were DNR). Of the 22% who failed NIV requiring invasive mechanical ventilation, the average age was 63 years and 50% were not initially admitted to an ICU. Underlying lung disease was noted in 50%, 50% had HTN, 33% had CV disease, and 33% had diabetes. With regard to disposition, 12% were discharged home, 12% were discharged to a long term acute care hospital and 76% died. In this group, the average time to NIV from admission in survivors was an average of 1 hour vs. an average of 3.5 hours in non-survivors. On average, survivors spent 3.5 hours on NIV while non-survivors spent 23 hours on NIV. Survivors spent an average of 6.5 days on invasive ventilation while non-survivors spent an average of 4.5 days on invasive ventilation.

CONCLUSIONS: Patients had a higher trend toward death if NIV was initiated longer into their hospital stay and were not initially admitted to an ICU. Those who required invasive ventilation and died compared to survivors were not initially admitted to the ICU, had a longer time to NIV initiation, a longer time on NIV, and were on the vent for fewer days. Additionally, they were younger and had a higher incidence of diabetes.

CLINICAL IMPLICATIONS: Larger studies evaluating NIV failure and death must be further investigated to evaluate transition tmie to invasive ventilation and discern if diabetes alone impacts death in respiratory failure.

DISCLOSURE: The following authors have nothing to disclose: Ginger Tsai-Nguyen, Avery Smith, Katharine Gaston, Pamela Hoof, Adan Mora

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