Critical Care: Mechanical Ventilation & Respiratory Failure I |

Utility- and Indication-Based Outcomes of Non-Invasive Positive Pressure Ventilation in Acute Respiratory Failure: A Single Center Retrospective Study FREE TO VIEW

Carrie Leong, MBBS; Constance Wei-Shan Teo, RRT; You Kai Poh, MBBS; Huihua Li, PhD; Ivan Gerald Lee, RRT; Chee Kiang Melvin Tay, MBBS; Thun How Ong, MBBS; Chian Min Loo, MBBS; Su Ying Low, MBBS
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Singapore General Hospital, Singapore, Singapore

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):309A. doi:10.1016/j.chest.2016.08.322
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF), and is seeing growing use. The objectives of this retrospective study are to identify conditions for which NIV was initiated in ARF, predictors of NIV failure and mortality across different NIV indications.

METHODS: A retrospective review of patients admitted to our hospital between 01/04/2013 and 01/04/2014, and commenced on NIV, was done. Data on NIV indication, demographics, arterial blood gas results, clinical parameters, and outcomes including need for endotracheal intubation (ETI) and mortality, were obtained. NIV failure was defined as requiring ETI, or demise while on NIV or within 48 hours of discontinuation. Univariate logistic regression analysis was used to identify predictors of NIV failure and mortality.

RESULTS: 159 patients (58.5% males, mean age 66.4 ± 14.9 years) were included. Indications for NIV were classified as: Acute pulmonary oedema (37.1%), COPD exacerbation (25.8%), acute respiratory failure (ARF) in immunocompromised host (ICH) (15.1%), obesity hypoventilation syndrome (OHS)/obstructive sleep apnea (OSA) (11.9%), pneumonia (7.5%), others (7.5%), palliation (3.8%), neuromuscular weakness (3.1%), restrictive lung disease (2.5%), asthma exacerbation (2.5%) and bronchiectasis exacerbation (1.9%). Amongst different indications excluding palliation, restrictive lung disease had the highest failure rate of 75%, followed by ARF in ICH (40.9%), bronchiectasis exacerbation (33.3%), pneumonia (25%), neuromuscular weakness (20%), acute pulmonary oedema (12.1%), OHS/OSA (10.5%), COPD Exacerbation (10%), others (8.3%) and asthma exacerbation (0%). Amongst different indications excluding palliation, ARF in ICH had the highest 30 day mortality of 37.5%, followed by restrictive lung disease (25%), asthma exacerbation (25%), others (25%), acute pulmonary oedema (18.6%), COPD exacerbation (12.2%) and pneumonia (8.3%). There were no mortalities for bronchiectasis exacerbation, neuromuscular weakness or OHS/OSA. There were no statistically significant variables (ideal body weight, pH/PaCO2/PaO2 change at 30 minutes post NIV, and respiratory rate at 30 minutes post NIV), which predicted risk of NIV failure or mortality at 30 days. However, NIV failure was a risk factor for mortality (OR=5.138, p=<0.0001).

CONCLUSIONS: Acute pulmonary oedema was the most common indication for NIV in ARF in our institution. Restrictive lung disease had the highest failure rate amongst different indications. Patients who failed NIV had a higher mortality risk.

CLINICAL IMPLICATIONS: An improved understanding of factors contributing to failure in the application of NIV in ARF, may improve clinical decision making and outcomes in the future.

DISCLOSURE: The following authors have nothing to disclose: Carrie Leong, Constance Wei-Shan Teo, You Kai Poh, Huihua Li, Ivan Gerald Lee, Chee Kiang Melvin Tay, Thun How Ong, Chian Min Loo, Su Ying Low

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