Intensive Care Medicine

, Volume 31, Issue 4, pp 533–539

Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure

  • Jason Phua
  • Kien Kong
  • Kang Hoe Lee
  • Liang Shen
  • T. K. Lim
Original

Abstract

Objective

This study compared the effectiveness of noninvasive ventilation (NIV) and the risk factors for NIV failure in hypercapnic acute respiratory failure (ARF) due to chronic obstructive pulmonary disease (COPD) vs. non-COPD conditions.

Design and setting

Prospective cohort study in the medical intensive care unit of a university hospital.

Patients and participants

111 patients with hypercapnic ARF, 43 of whom had COPD exacerbations and 68 other conditions. Baseline characteristics of the two groups were similar.

Measurements and results

The risk of NIV failure, defined as the need for endotracheal intubation, was significantly lower in COPD than in other conditions (19% vs. 47%). High APACHE II score was an independent predictor of NIV failure in COPD (OR 5.38 per 5 points). The presence of pneumonia (OR 5.63), high APACHE II score (OR 2.59 per 5 points), rapid heart rate (OR 1.22 per 5 beats/min), and high PaCO2 1 h after NIV (OR 1.22 per 5 mmHg) were independent predictors of NIV failure in the non-COPD group. Failure of NIV independently predicted mortality (OR 10.53).

Conclusions

Noninvasive ventilation was more effective in preventing endotracheal intubation in hypercapnic ARF due to COPD than non-COPD conditions. High APACHE II score predicted NIV failure in both groups. Noninvasive ventilation was least effective in patients with hypercapnic ARF due to pneumonia.

Keywords

Noninvasive ventilation Hypercapnic acute respiratory failure Chronic obstructive pulmonary disease Pneumonia 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Jason Phua
    • 1
  • Kien Kong
    • 1
  • Kang Hoe Lee
    • 1
  • Liang Shen
    • 2
  • T. K. Lim
    • 1
  1. 1.Division of Respiratory and Critical Care Medicine, Department of MedicineNational University HospitalSingapore
  2. 2.Clinical Trials and Epidemiology Research UnitSingapore

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