The effect of non-invasive ventilation on long-term survival in acute hypoxemic respiratory failure. An observational study of 12,428 patients stratified by the Berlin definition gas exchange criteria.
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 121, AP-04Article in journal, Meeting abstract (Other academic) Published
Introduction: Noninvasive positive pressure ventilation (NIV) has become a standard therapy for the treatment of respiratory failure in chronic obstructive pulmonary disease (COPD), while the increasing early use in patients with hypoxemic acute respiratory failure (ARF) is controversial. The aim of the present study was to examine the influence of NIV and particularly when NIV was followed by invasive ventilation (NIV+InvV) in hypoxic ARF.
Methods: The use of early NIV and invasive mechanical ventilation (InvV) was examined in patients admitted with respiratory failure to 70 ICUs during 2008–2014. Exclusions were age < 16 years, patients with COPD, and when oxygenation or ventilation support data were missing. The ratio of PaO2 to FiO2 (P/F) was used to group patients with mild (26.7–40.0 kPa), moderate (13.3–26.6 kPa) and severe (< 13.3 kPa) ARF. Survival was analyzed using a multivariable Cox model after stratification by P/F ratio and adjusting for hospital category, age, comorbidities and derangements in acute physiology (except P/F ratio) as defined in the SAPS3 model.
Results: NIV was the initial mode in 48.7% of pts. with hypoxemic ARF. NIV only and NIV+InvV were associated with increased mortality compared to invasive ventilation only (Table). Conclusion: The use of early NIV in hypoxemic ARF was high. NIV was associated with increased mortality which may be explained by residual confounding (i.e. presence/absence of care limitations), although the finding with NIV+InvV is of concern. Early NIV must be used with care in hypoxemic ARF until proper studies have identified patients who truly benefit from NIV.
Place, publisher, year, edition, pages
Wiley-Blackwell, 2015. Vol. 59, no 121, AP-04
IdentifiersURN: urn:nbn:se:liu:diva-125569DOI: 10.1111/aas.12556OAI: oai:DiVA.org:liu-125569DiVA: diva2:907064
33rd Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Matters of the heart, Reykavik, Iceland, 10-12 June 2015