Intensive Care Medicine

, Volume 32, Issue 11, pp 1756–1765 | Cite as

Benefits and risks of success or failure of noninvasive ventilation

  • Alexandre Demoule
  • Emmanuelle Girou
  • Jean-Christophe Richard
  • Solenne Taille
  • Laurent Brochard
Original

Abstract

Objective

Noninvasive ventilation (NIV) fails more frequently for de novo acute respiratory failure (de novo) than for cardiogenic pulmonary edema (CPE) or acute-on-chronic respiratory failure (AOC). The impact of NIV failure and success was compared between de novo and CPE or AOC after adjustment for disease severity.

Settings

Patients requiring ventilatory support were enrolled in a prospective survey in 70 French ICUs. Of 1076 patients requiring ventilatory support, 524 were eligible, including 299 de novo (NIV use, 30%) and 225 CPE-AOC (NIV use, 55%).

Design and analysis

Independent risk factors associated with mortality and length of stay were identified by logistic regression analysis. The adjusted outcome of NIV success or failure was compared to that with endotracheal intubation without NIV.

Results

NIV success was independently associated with survival in both de novo, adjusted OR 0.05 (95% CI 0.01–0.42), and CPE-AOC OR 0.03 (CI 0.01–0.24). NIV failure was associated with ICU mortality in the de novo group (OR 3.24, CI 1.61–6.53) but not in the CPE-AOC group. Nosocomial pneumonia was less common in patients successful with NIV. NIV failure was associated with a longer ICU stay in CPE-AOC only. The overall use of NIV was independently associated with a better outcome only in CPE-AOC patients (OR 0.33, CI 0.15–0.73).

Conclusion

The effect of NIV differs between de novo and CPE-AOC patients because NIV failure is associated with increased mortality for de novo patients. This finding should raise a note of caution when applying NIV in this indication.

Keywords

Chronic obstructive pulmonary disease Nosocomial pneumonia Cardiogenic pulmonary edema Endotracheal intubation Acute respiratory failure 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Alexandre Demoule
    • 1
    • 2
  • Emmanuelle Girou
    • 2
    • 3
    • 4
  • Jean-Christophe Richard
    • 5
  • Solenne Taille
    • 1
  • Laurent Brochard
    • 1
    • 2
    • 6
  1. 1.Service de Réanimation MédicaleAP-HP, Hôpital Henri MondorCréteilFrance
  2. 2.Faculté de MédecineUniversité Paris 12CréteilFrance
  3. 3.CEPIAP-HP, Hôpital Henri MondorCréteilFrance
  4. 4.CeRBEP-INSERM U657Institut PasteurParisFrance
  5. 5.Réanimation MédicaleHôpital Charles NicolleRouenFrance
  6. 6.INSERM U 651CréteilFrance

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