Intensive Care Medicine

, Volume 35, Issue 4, pp 663–670

Noninvasive ventilation for acute respiratory failure after lung resection: an observational study

  • Aurélie Lefebvre
  • Christine Lorut
  • Marco Alifano
  • Hervé Dermine
  • Nicolas Roche
  • Rémy Gauzit
  • Jean-François Regnard
  • Gérard Huchon
  • Antoine Rabbat
Original

Abstract

Background

A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome.

Method

We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation.

Results

Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P < 0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5; 95% confidence interval, 1.9–68.3; P = 0.007) and no initial response to NIV (odds ratio, 117.6; 95% confidence interval, 10.6–1305.8; P = 0.0001).

Conclusion

This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection.

Keywords

Noninvasive ventilation Acute respiratory failure Postoperative thoracic surgery Lung resection COPD Outcomes 

Supplementary material

134_2008_1317_MOESM1_ESM.rtf (70 kb)
Electronic supplementary material (RTF 70 kb)

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Aurélie Lefebvre
    • 1
  • Christine Lorut
    • 1
  • Marco Alifano
    • 2
  • Hervé Dermine
    • 3
  • Nicolas Roche
    • 1
  • Rémy Gauzit
    • 3
  • Jean-François Regnard
    • 2
  • Gérard Huchon
    • 1
  • Antoine Rabbat
    • 1
    • 4
  1. 1.Department of Respiratory and Intensive Care MedicineHôtel-Dieu Hospital, AP-HP, Université Paris 5ParisFrance
  2. 2.Department of Thoracic SurgeryHôtel-Dieu Hospital, AP-HP, Université Paris 5ParisFrance
  3. 3.Department of Anesthesiology and Surgical Intensive CareHôtel-Dieu Hospital, AP-HP, Université Paris 5ParisFrance
  4. 4.Pneumologie et RéanimationHôtel-DieuParis Cedex 04France

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