Intensive Care Medicine

, Volume 36, Issue 4, pp 638–647 | Cite as

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



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.


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.


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).


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.


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


  1. 1.
    Barker AF, Bardana EJ Jr (1988) Bronchiectasis: update of an orphan disease. Am Rev Respir Dis 137:969–978PubMedGoogle Scholar
  2. 2.
    Tsang KW, Tipoe GL (2004) Bronchiectasis: not an orphan disease in the East. Int J Tuberc Lung Dis 8:691–702PubMedGoogle Scholar
  3. 3.
    O’Donnell AE (2008) Bronchiectasis. Chest 134:815–823CrossRefPubMedGoogle Scholar
  4. 4.
    Loebinger MR, Wells AU, Hansell DM, Chinyanganya N, Devaraj A, Meister M, Wilson R (2009) Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J 34:843–849CrossRefPubMedGoogle Scholar
  5. 5.
    Onen ZP, Gulbay BE, Sen E, Yildiz OA, Saryal S, Acican T, Karabiyikoglu G (2007) Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med 101:1390–1397CrossRefPubMedGoogle Scholar
  6. 6.
    Keistinen T, Saynajakangas O, Tuuponen T, Kivela SL (1997) Bronchiectasis: an orphan disease with a poorly understood prognosis. Eur Respir J 10:2784–2787CrossRefPubMedGoogle Scholar
  7. 7.
    Ellis DA, Thornley PE, Wightman AJ, Walker M, Chalmers J, Crofton JW (1981) Present outlook in bronchiectasis: clinical and social study and review of factors influencing prognosis. Thorax 36:659–664CrossRefPubMedGoogle Scholar
  8. 8.
    Dupont M, Gacouin A, Lena H, Lavoue S, Brinchault G, Delaval P, Thomas R (2004) Survival of patients with bronchiectasis after the first ICU stay for respiratory failure. Chest 125:1815–1820CrossRefPubMedGoogle Scholar
  9. 9.
    Alzeer AH, Masood M, Basha SJ, Shaik SA (2007) Survival of bronchiectatic patients with respiratory failure in ICU. BMC Pulm Med 7:17CrossRefPubMedGoogle Scholar
  10. 10.
    Garpestad E, Brennan J, Hill NS (2007) Noninvasive ventilation for critical care. Chest 132:711–720CrossRefPubMedGoogle Scholar
  11. 11.
    Naidich DP, McCauley DI, Khouri NF, Stitik FP, Siegelman SS (1982) Computed tomography of bronchiectasis. J Comput Assist Tomogr 6:437–444PubMedCrossRefGoogle Scholar
  12. 12.
    McGuinness G, Naidich DP (2002) CT of airways disease and bronchiectasis. Radiol Clin North Am 40:1–19CrossRefPubMedGoogle Scholar
  13. 13.
    Ropper AH (2008) Coma. In: Fauci AS (ed) Harrison’s principles of internal medicine, 17th edn. McGraw-Hill, New York, pp 1714–1719Google Scholar
  14. 14.
    Phua J, Kong K, Lee KH, Shen L, Lim TK (2005) Noninvasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease versus other conditions: effectiveness and predictors of failure. Intensive Care Med 31:533–539CrossRefPubMedGoogle Scholar
  15. 15.
    Ai-Ping C, Lee KH, Lim TK (2005) In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. Chest 128:518–524CrossRefPubMedGoogle Scholar
  16. 16.
    Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176:532–555CrossRefPubMedGoogle Scholar
  17. 17.
    Reid LM (1950) Reduction in bronchial subdivision in bronchiectasis. Thorax 5:233–247CrossRefPubMedGoogle Scholar
  18. 18.
    Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–S72CrossRefPubMedGoogle Scholar
  19. 19.
    Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442CrossRefPubMedGoogle Scholar
  20. 20.
    American Thoracic Society; Centers for Disease Control and Prevention; Infectious Disease Society of America (2000) Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 161:1376–1395Google Scholar
  21. 21.
    Muller NL, Fraser RS, Colman NC, Pare PD (2001) Radiologic diagnosis of diseases of the chest. W. B. Saunders, PhiladelphiaGoogle Scholar
  22. 22.
    Scala R, Naldi M, Archinucci I, Coniglio G, Nava S (2005) Noninvasive positive pressure ventilation in patients with acute exacerbations of COPD and varying levels of consciousness. Chest 128:1657–1666CrossRefPubMedGoogle Scholar
  23. 23.
    Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet 371:126–134CrossRefPubMedGoogle Scholar
  24. 24.
    Mukhopadhyay A, Dela Pena E, Wadden B, Procyshyn M, Lim TK (2009) Effects of inhalational bronchdilator treatment during non-invasive ventilation in severe COPD exacerbations. J Crit Care 24:474, e1–5Google Scholar
  25. 25.
    Confalonieri M, Garuti G, Cattaruzza MS, Osborn JF, Antonelli M, Conti G, Kodric M, Resta O, Marchese S, Gregoretti C, Rossi A (2005) A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J 25:348–355CrossRefPubMedGoogle Scholar
  26. 26.
    Schoenfeld DA, Bernard GR (2002) Statistical evaluation of ventilator-free days as an efficacy measure in clinical trials of treatments for acute respiratory distress syndrome. Crit Care Med 30:1772–1777CrossRefPubMedGoogle Scholar
  27. 27.
    Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056CrossRefPubMedGoogle Scholar
  28. 28.
    Simonds AK, Elliott MW (1995) Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders. Thorax 50:604–609CrossRefPubMedGoogle Scholar
  29. 29.
    Gacouin A, Desrues B, Lena H, Quinquenel ML, Dassonville J, Delaval P (1996) Long-term nasal intermittent positive pressure ventilation (NIPPV) in sixteen consecutive patients with bronchiectasis: a retrospective study. Eur Respir J 9:1246–1250CrossRefPubMedGoogle Scholar
  30. 30.
    Benhamou D, Muir JF, Raspaud C, Cuvelier A, Girault C, Portier F, Menard JF (1997) Long-term efficiency of home nasal mask ventilation in patients with diffuse bronchiectasis and severe chronic respiratory failure: a case-control study. Chest 112:1259–1266CrossRefPubMedGoogle Scholar
  31. 31.
    Moran F, Bradley JM, Piper AJ (2009) Non-invasive ventilation for cystic fibrosis. Cochrane Database Syst Rev CD002769Google Scholar
  32. 32.
    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 27:1718–1728CrossRefPubMedGoogle Scholar
  33. 33.
    Ambrosino N, Foglio K, Rubini F, Clini E, Nava S, Vitacca M (1995) Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success. Thorax 50:755–757CrossRefPubMedGoogle Scholar
  34. 34.
    Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto Meduri G (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
  35. 35.
    Jolliet P, Abajo B, Pasquina P, Chevrolet JC (2001) Non-invasive pressure support ventilation in severe community-acquired pneumonia. Intensive Care Med 27:812–821CrossRefPubMedGoogle Scholar
  36. 36.
    Fernandez R, Baigorri F, Artigas A (2007) Noninvasive ventilation in patients with “do-not-intubate” orders: medium-term efficacy depends critically on patient selection. Intensive Care Med 33:350–354CrossRefPubMedGoogle Scholar
  37. 37.
    Schettino G, Altobelli N, Kacmarek RM (2005) Noninvasive positive pressure ventilation reverses acute respiratory failure in select “do-not-intubate” patients. Crit Care Med 33:1976–1982CrossRefPubMedGoogle Scholar
  38. 38.
    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 326:185CrossRefPubMedGoogle Scholar
  39. 39.
    Conti G, Antonelli M, Navalesi P, Rocco M, Bufi M, Spadetta G, Meduri GU (2002) Noninvasive versus conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med 28:1701–1707CrossRefPubMedGoogle Scholar
  40. 40.
    Keenan SP, Sinuff T, Cook DJ, Hill NS (2003) Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med 138:861–870PubMedGoogle Scholar

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

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