[Noninvasive ventilation for acute respiratory failure in a pulmonary department]

Abstract

Introduction: Noninvasive ventilation (NIV) is considered as the first choice treatment for selected patients with acute respiratory failure (ARF), but many hospitals are forced to start NIV on medical wards.

Methods: The aim of this retrospective study was to assess the outcomes of NIV initiated for ARF on a respiratory ward and to find the criteria predictive of failure. All patients were treated in a four-bed ward specifically dedicated to NIV. Failure of NIV was defined as the need for intubation and transfer to ICU, or death.

Results: Among 105 admissions with ARF, 49 episodes needed NIV. These episodes were divided into 2 groups: PaCO2<45mmHg (10) and PaCO2>45mmHg (39). The overall failure rate of NIV and overall in-hospital mortality rate were 26.5% and 17% respectively. On multivariate analysis, SAPS II and respiratory acidosis with a pH less than 7.30 were significantly associated with failure of NIV.

Conclusions: NIV is practicable and is effective in the management of mild to moderate ARF on a respiratory ward. However, patients with respiratory acidosis and a pH less than 7.30 are at risk of NIV failure.

Keywords: Acute cardiogenic pulmonary edema; Acute respiratory failure; Bronchopneumopathie chronique obstructive; Chronic obstructive pulmonary disease; Chronic respiratory failure; Insuffisance respiratoire aiguë; Insuffisance respiratoire chronique; Noninvasive ventilation; Ventilation non invasive; Œdème aigu pulmonaire cardiogénique.