Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications

doi:10.1186/s13613-015-0044-1

. 2015 Mar 6:5:4.

doi: 10.1186/s13613-015-0044-1. eCollection 2015.

Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications

Jarrod M Mosier¹, John C Sakles², Sage P Whitmore³, Cameron D Hypes⁴, Danielle K Hallett², Katharine E Hawbaker², Linda S Snyder⁵, John W Bloom⁵

Affiliations

¹ Section of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85721 USA ; Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave., Tucson, AZ 85724 USA ; University of Arizona, 1609N Warren, FOB 122C, Tucson, AZ 85719 USA.
² Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave., Tucson, AZ 85724 USA.
³ Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI 48109 USA.
⁴ Section of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85721 USA ; Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave., Tucson, AZ 85724 USA.
⁵ Section of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85721 USA.

PMID: 25852964
PMCID: PMC4385202
DOI: 10.1186/s13613-015-0044-1

Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications

Jarrod M Mosier et al. Ann Intensive Care. 2015.

. 2015 Mar 6:5:4.

doi: 10.1186/s13613-015-0044-1. eCollection 2015.

Authors

Jarrod M Mosier¹, John C Sakles², Sage P Whitmore³, Cameron D Hypes⁴, Danielle K Hallett², Katharine E Hawbaker², Linda S Snyder⁵, John W Bloom⁵

Affiliations

¹ Section of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85721 USA ; Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave., Tucson, AZ 85724 USA ; University of Arizona, 1609N Warren, FOB 122C, Tucson, AZ 85719 USA.
² Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave., Tucson, AZ 85724 USA.
³ Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI 48109 USA.
⁴ Section of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85721 USA ; Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave., Tucson, AZ 85724 USA.
⁵ Section of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85721 USA.

PMID: 25852964
PMCID: PMC4385202
DOI: 10.1186/s13613-015-0044-1

Abstract

Background: Noninvasive positive-pressure ventilation (NIPPV) use has increased in the treatment of patients with respiratory failure. However, despite decreasing the need for intubation in some patients, there are no data regarding the risk of intubation-related complications associated with delayed intubation in adult patients who fail NIPPV. The objective of this study is to evaluate the odds of a composite complication of intubation following failed NIPPV compared to patients intubated primarily in the medical intensive care unit (ICU).

Methods: This is a single-center retrospective cohort study of 235 patients intubated between 1 January 2012 and 30 June 2013 in a medical ICU of a university medical center. A total of 125 patients were intubated after failing NIPPV, 110 patients were intubated without a trial of NIPPV. Intubation-related data were collected prospectively through a continuous quality improvement (CQI) program and retrospectively extracted from the medical record on all patients intubated on the medical ICU. A propensity adjustment for the factors expected to affect the decision to initially use NIPPV was used, and the adjusted multivariate regression analysis was performed to evaluate the odds of a composite complication (desaturation, hypotension, or aspiration) with intubation following failed NIPPV versus primary intubation.

Results: A propensity-adjusted multivariate regression analysis revealed that the odds of a composite complication of intubation in patients who fail NIPPV was 2.20 (CI 1.14 to 4.25), when corrected for the presence of pneumonia or acute respiratory distress syndrome (ARDS), and adjusted for factors known to increase complications of intubation (total attempts and operator experience). When a composite complication occurred, the unadjusted odds of death in the ICU were 1.79 (95% CI 1.03 to 3.12).

Conclusions: After controlling for potential confounders, this propensity-adjusted analysis demonstrates an increased odds of a composite complication with intubation following failed NIPPV. Further, the presence of a composite complication during intubation is associated with an increased odds of death in the ICU.

Keywords: Airway management; Aspiration; Critical care; Delayed intubation; Desaturation; Hypotension; Intubation; NIPPV; Noninvasive positive pressure.

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References

1. Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998–2008. Am J Respir Crit Care Med. 2012;185:152–9. doi: 10.1164/rccm.201106-1094OC. - DOI - PMC - PubMed
1. Schnell D, Timsit JF, Darmon M, Vesin A, Goldgran-Toledano D, Dumenil AS, et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med. 2014;40:582–91. doi: 10.1007/s00134-014-3222-y. - DOI - PubMed
1. Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. 2003;124:699–713. doi: 10.1378/chest.124.2.699. - DOI - PubMed
1. Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet. 1993;341:1555–7. doi: 10.1016/0140-6736(93)90696-E. - DOI - PubMed
1. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333:817–22. doi: 10.1056/NEJM199509283331301. - DOI - PubMed

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[1] Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998–2008. Am J Respir Crit Care Med. 2012;185:152–9. doi: 10.1164/rccm.201106-1094OC. - DOI - PMC - PubMed

[2] Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998–2008. Am J Respir Crit Care Med. 2012;185:152–9. doi: 10.1164/rccm.201106-1094OC. - DOI - PMC - PubMed

[3] Schnell D, Timsit JF, Darmon M, Vesin A, Goldgran-Toledano D, Dumenil AS, et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med. 2014;40:582–91. doi: 10.1007/s00134-014-3222-y. - DOI - PubMed

[4] Schnell D, Timsit JF, Darmon M, Vesin A, Goldgran-Toledano D, Dumenil AS, et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med. 2014;40:582–91. doi: 10.1007/s00134-014-3222-y. - DOI - PubMed

[5] Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. 2003;124:699–713. doi: 10.1378/chest.124.2.699. - DOI - PubMed

[6] Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. 2003;124:699–713. doi: 10.1378/chest.124.2.699. - DOI - PubMed

[7] Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet. 1993;341:1555–7. doi: 10.1016/0140-6736(93)90696-E. - DOI - PubMed

[8] Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet. 1993;341:1555–7. doi: 10.1016/0140-6736(93)90696-E. - DOI - PubMed

[9] Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333:817–22. doi: 10.1056/NEJM199509283331301. - DOI - PubMed

[10] Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333:817–22. doi: 10.1056/NEJM199509283331301. - DOI - PubMed

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Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications

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Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications

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Abstract

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