Intensive Care Medicine

, Volume 27, Issue 11, pp 1718–1728

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

Authors

  • M. Antonelli
    • Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome
  • G. Conti
    • Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome
  • M. Moro
    • Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome
  • A. Esquinas
    • Hospital M Meseguer, Murcia
  • G. Gonzalez-Diaz
    • Hospital M Meseguer, Murcia
  • M. Confalonieri
    • Unità di Terapia Intensiva Respiratoria, Ospedali Riuniti di Bergamo
  • P. Pelaia
    • Ospedale Universitario Torrette, Ancona
  • T. Principi
    • Ospedale Universitario Torrette, Ancona
  • C. Gregoretti
    • Servizio di Anestesia CTO, Torino
  • F. Beltrame
    • Istituto ARTA, Università di Trieste
  • M. Pennisi
    • Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome
  • A. Arcangeli
    • Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome
  • R. Proietti
    • Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome
  • M. Passariello
    • Istituto di Anestesiologia e Rianimazione, Università La Sapienza
  • G. Meduri
    • Department of Medicine, Pulmonary and Critical Care Division, University of Tennessee, Memphis
Original

DOI: 10.1007/s00134-001-1114-4

Cite this article as:
Antonelli, M., Conti, G., Moro, M. et al. Intensive Care Med (2001) 27: 1718. doi:10.1007/s00134-001-1114-4

Abstract.

Context: 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. Objective: To investigate variables predictive of NPPV failure in patients with hypoxemic ARF. Design: Prospective, multicenter cohort study. Setting: Eight Intensive Care Units (ICU) in Europe and USA. Patients: 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. Results: 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) ≥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 ≤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). Conclusions: 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.

Noninvasive positive pressure ventilation Acute hypoxemic respiratory failure Endotracheal intubation Prospective, multicenter cohort study
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© Springer-Verlag 2001