Intensive Care Medicine

, Volume 36, Issue 4, pp 638–647

Noninvasive and invasive ventilation in acute respiratory failure associated with bronchiectasis

  • Jason Phua
  • Yvonne L. E. Ang
  • Kay Choong See
  • Amartya Mukhopadhyay
  • Erlinda A. Santiago
  • Eleanor G. Dela Pena
  • Tow Keang Lim
Original

DOI: 10.1007/s00134-009-1743-6

Cite this article as:
Phua, J., Ang, Y.L.E., See, K.C. et al. Intensive Care Med (2010) 36: 638. doi:10.1007/s00134-009-1743-6

Abstract

Purpose

To describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure.

Methods

Retrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV.

Results

At baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO2/FiO2 ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO2/FiO2 ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease).

Conclusions

The hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients.

Keywords

Bronchiectasis Respiratory failure Non-invasive positive-pressure ventilation Mechanical ventilation Mortality 

Copyright information

© Copyright jointly hold by Springer and ESICM 2010

Authors and Affiliations

  • Jason Phua
    • 1
  • Yvonne L. E. Ang
    • 2
  • Kay Choong See
    • 1
  • Amartya Mukhopadhyay
    • 1
  • Erlinda A. Santiago
    • 1
  • Eleanor G. Dela Pena
    • 1
  • Tow Keang Lim
    • 1
  1. 1.Division of Respiratory and Critical Care Medicine, Department of MedicineNational University HospitalSingaporeSingapore
  2. 2.School of Clinical MedicineUniversity of CambridgeCambridgeUK