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



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.


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.


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).


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


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)


  1. 1.
    Kutlu CA, Williams EA, Evans TW, Pastorino U, Goldstaw P (2000) Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 69:376–380PubMedCrossRefGoogle Scholar
  2. 2.
    Aguilo R, Togores B, Pons S, Rubi M, Barbe F, Agusti AGN (1997) Noninvasive ventilatory support after lung resectional surgery. Chest 112:117–121PubMedCrossRefGoogle Scholar
  3. 3.
    Auriant I, Jallot A, Hervé P, Cerrina J, Leroy Ladurie F, Fournier JL, Lescot B, Parquin F (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164:1231–1235PubMedGoogle Scholar
  4. 4.
    Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251PubMedCrossRefGoogle Scholar
  5. 5.
    Yano T, Yokoyama H, Fukuyama Y, Takai E, Mizutani K, Ichinose Y (1997) The current status of postoperative complications and risk factors after a pulmonary resection for primary lung cancer: a multivariate analysis. Eur J Cardiothorac Surg 11:445–449PubMedCrossRefGoogle Scholar
  6. 6.
    Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T, Oyama T, Osaki T, Yasumoto K (2001) Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer. Thorax 56:59–61PubMedCrossRefGoogle Scholar
  7. 7.
    Algar FJ, Alvarez A, Salvatierra A, Baamonde C, Aranda JL, Lopez-Pujol FJ (2003) Predicting pulmonary complications after pneumonectomy for lung cancer. Eur J Cardiothorac Surg 23:201–208PubMedCrossRefGoogle Scholar
  8. 8.
    Schussler O, Alifano M, Dermine H, Strano S, Casetta A, Sepulveda S, Chafik A, Coignard S, Rabbat A, Regnard JF (2006) Postoperative pneumonia after major lung resection. Am J Respir Crit Care Med 173:1161–1169PubMedCrossRefGoogle Scholar
  9. 9.
    Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelli B, Bonnet F (2000) Pulmonary complications following lung resection : a comprehensive analysis of incidence and possible risk factors. Chest 118:1263–1270PubMedCrossRefGoogle Scholar
  10. 10.
    Demoule A, Girou E, Richard JC, Taillé S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755PubMedCrossRefGoogle Scholar
  11. 11.
    Girault C, Briel A, Hellot MF, Tamion F, Woinet D, Leroy J, Bonmarchand G (2003) Noninvasive mechanical ventilation in clinical practice: a 2-year experience in a medical intensive care unit. Crit Care Med 31:552–559PubMedCrossRefGoogle Scholar
  12. 12.
    Brochard L, Mancebo J, Wysocky M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F, Isabey D, Harf A (1995) Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med 333:817–822PubMedCrossRefGoogle Scholar
  13. 13.
    Wysocki M, Antonelli M (2001) Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure. Eur Respir J 18:209–220PubMedCrossRefGoogle Scholar
  14. 14.
    Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444PubMedCrossRefGoogle Scholar
  15. 15.
    Martin TJ, Hovis JD, Costantino JP, Bierman MI, Donahoe MP, Rogers RM, Kreit JW, Sciurba FC, Stiller RA, Sanders MH (2000) A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 161:807–813PubMedGoogle Scholar
  16. 16.
    Plant PK, Owen JL, Elliott MW (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicenter randomised controlled trial. Lancet 355:1931–1935PubMedCrossRefGoogle Scholar
  17. 17.
    Lightowler JV, Wedzicha JA, Elliott MW, Ram FS (2003) Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: cochrane systematic review and meta-analysis. BMJ 326:185PubMedCrossRefGoogle Scholar
  18. 18.
    Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Meduri UG (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585–1591PubMedGoogle Scholar
  19. 19.
    Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti G, Guerin C, Schortgen F, Lefort Y, Antonelli M, Lepage E, Lemaire F, Brochard L (2000) Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA 284:2352–2360PubMedCrossRefGoogle Scholar
  20. 20.
    Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, Epstein SK, Hill NS, Nava S, Soares MA, D’Empaire G, Alia I, Anzueto A (2004) Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 350:2452–2460PubMedCrossRefGoogle Scholar
  21. 21.
    Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, Rodriguez-Roisin R, Torres A (2003) Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 168:70–76PubMedCrossRefGoogle Scholar
  22. 22.
    Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, Pelaia P, Principi T, Gregoretti C, Beltrame F, Pennisi MA, Arcangeli A, Proietti R, Passariello M, Meduri GU (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728PubMedCrossRefGoogle Scholar
  23. 23.
    Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880PubMedGoogle Scholar
  24. 24.
    Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med 32:1756–1765PubMedCrossRefGoogle Scholar
  25. 25.
    Duncan SR, Negrin RS, Mihm FG, Guilleminault C, Raffin TA (1987) Nasal continuous positive airway pressure in atelectasis. Chest 92:621–624PubMedCrossRefGoogle Scholar
  26. 26.
    Jaber S, Gallix B, Sebbane M (2005) Noninvasive ventilation improves alveolar recruitment on postoperative patients with acute respiratory failure: a CT-scan study. Intensive Care Med 31:S148CrossRefGoogle Scholar
  27. 27.
    Perrin C, Jullien V, Venissac N, Berthier F, Padovani B, Guillot F, Coussement A, Mouroux J (2007) Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Respir Med 101:1572–1578PubMedCrossRefGoogle Scholar
  28. 28.
    Nava S, Navalesi P, Conti G (2006) Time of non-invasive ventilation. Intensive Care Med 32:361–370PubMedCrossRefGoogle Scholar
  29. 29.
    Nan DN, Fernandez-Ayala M, Farinas-Alvarez C, Mons R, Ortega FJ, Gonzalez-Macias J, Farinas MC (2005) Nosocomial infection after lung surgery: incidence and risk factors. Chest 128:2647–2652PubMedCrossRefGoogle Scholar
  30. 30.
    Gilljam M, Chaparro C, Tullis E, Chan C, Keshavjee S, Hutcheon M (2003) GI complications after lung transplantation in patients with cystic fibrosis. Chest 123:37–41PubMedCrossRefGoogle Scholar
  31. 31.
    Fraisse A, Brosse S, Manckoundia P, Popitean L, Pfitznemeyer P (2003) Ogilvie syndrome in the elderly: retrospective study in 40 cases. Presse Med 32:1500–1504PubMedGoogle Scholar
  32. 32.
    Scala R, Bartolucci S, Naldi M, Rossi M, Elliott MW (2004) Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation. Intensive Care Med 30:1747–1754PubMedCrossRefGoogle Scholar
  33. 33.
    Rabbat A, Chaoui D, Montani D, Legrand O, Lefebvre A, Rio B (2005) Prognosis of patients with acute myeloid leukemia admitted in intensive care. Br J Haematol 129:350–357PubMedCrossRefGoogle Scholar
  34. 34.
    Carlucci A, Delmastro M, Rubini F, Fracchia C, Nava S (2003) Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years. Intensive Care Med 29:419–425PubMedGoogle Scholar
  35. 35.
    Confalonieri M, Garuti G, Cattaruzza MS, Osborn JF, Antonelli M, Conti G, Kodric M, Resta O, Marchese S, Gregoretti C, Rossi A, Italian noninvasive positive pressure ventilation (NPPV) study group (2005) A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J 25:348–355PubMedCrossRefGoogle Scholar
  36. 36.
    Meduri GU, Turner RE, Abou-Shala N, Wunderink R, Tolley E (1996) Noninvasive positive pressure ventilation via face mask. First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest 109:179–193PubMedCrossRefGoogle Scholar

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

Personalised recommendations