Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study

• DOI: 10.1007/s00134-001-1114-4
• Publication Date: 2002-10-06T13:35:24Z
• Authors: M. Antonelli; G. Conti; M. Moro; A. Esquinas; G. Gonzalez-Diaz; M. Confalonieri; P. Pelaia; T. Principi; C. Gregoretti; F. Beltrame; M. Pennisi; A. Arcangeli; R. Proietti; M. Passariello; G. Meduri
• Keywords: Adult; Male; Adolescent; Predictive Value of Test; Statistics, Nonparametric; Positive-Pressure Respiration; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Risk Factors; Noninvasive positive pressure ventilation; Intubation, Intratracheal; Humans; Treatment Failure; Prospective Studies; Acute hypoxemic respiratory failure; Aged; Aged, 80 and over; Chi-Square Distribution; Risk Factor; Middle Aged; Endotracheal intubation; Prospective, multicenter cohort study; Tennessee; 3. Good health; Prospective Studie; Acute hypoxemic respiratory failure; Endotracheal intubation; Noninvasive positive pressure ventilation; Prospective, multicenter cohort study; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Female; Humans; Intubation, Intratracheal; Italy; Male; Middle Aged; Positive-Pressure Respiration; Predictive Value of Tests; Prospective Studies; Respiratory Insufficiency; Risk Factors; Spain; Statistics, Nonparametric; Tennessee; Treatment Failure; Italy; Spain; Acute Disease; Female; Respiratory Insufficiency; Human

In patients with hypoxemic acute respiratory failure (ARF), randomized studies have shown noninvasive positive pressure ventilation (NPPV) to be associated with lower rates of endotracheal intubation. In these patients, predictors of NPPV failure are not well characterized.To investigate variables predictive of NPPV failure in patients with hypoxemic ARF.Prospective, multicenter cohort study.Eight Intensive Care Units (ICU) in Europe and USA.Of 5,847 patients admitted between October 1996 and December 1998, 2,770 met criteria for hypoxemic ARF. Of these, 2,416 were already intubated and 354 were eligible for the study.NPPV failed in 30% (108/354) of patients. The highest intubation rate was observed in patients with ARDS (51%) or community-acquired pneumonia (50%). The lowest intubation rate was observed in patients with cardiogenic pulmonary edema (10%) and pulmonary contusion (18%). Multivariate analysis identified age > 40 years (OR 1.72, 95% CI 0.92-3.23), a simplified acute physiologic score (SAPS II) > or = 35 (OR 1.81, 95% CI 1.07-3.06), the presence of ARDS or community-acquired pneumonia (OR 3.75, 95% CI 2.25-6.24), and a PaO2:FiO2 < or = 146 after 1 h of NPPV (OR 2.51, 95% CI 1.45-4.35) as factors independently associated with failure of NPPV. Patients requiring intubation had a longer duration of ICU stay ( P < 0.001), higher rates of ventilator-associated pneumonia and septic complications ( P < 0.001), and a higher ICU mortality ( P < 0.001).In hypoxemic ARF, NPPV can be successful in selected populations. When patients have a higher severity score, an older age, ARDS or pneumonia, or fail to improve after 1 h of treatment, the risk of failure is higher.