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Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study

INTRODUCTION: The role of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute lung injury (ALI) is controversial. We sought to assess the outcome of ALI that was initially treated with NIPPV and to identify specific risk factors for NIPPV failure. METHODS: In this observatio...

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Autores principales: Rana, Sameer, Jenad, Hussam, Gay, Peter C, Buck, Curtis F, Hubmayr, Rolf D, Gajic, Ognjen
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550938/
https://www.ncbi.nlm.nih.gov/pubmed/16696863
http://dx.doi.org/10.1186/cc4923
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author Rana, Sameer
Jenad, Hussam
Gay, Peter C
Buck, Curtis F
Hubmayr, Rolf D
Gajic, Ognjen
author_facet Rana, Sameer
Jenad, Hussam
Gay, Peter C
Buck, Curtis F
Hubmayr, Rolf D
Gajic, Ognjen
author_sort Rana, Sameer
collection PubMed
description INTRODUCTION: The role of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute lung injury (ALI) is controversial. We sought to assess the outcome of ALI that was initially treated with NIPPV and to identify specific risk factors for NIPPV failure. METHODS: In this observational cohort study at the two intensive care units of a tertiary center, we identified consecutive patients with ALI who were initially treated with NIPPV. Data on demographics, APACHE III scores, degree of hypoxemia, ALI risk factors and NIPPV respiratory parameters were recorded. Univariate and multivariate regression analyses were performed to identify risk factors for NIPPV failure. RESULTS: Of 79 consecutive patients who met the inclusion criteria, 23 were excluded because of a do not resuscitate order and two did not give research authorization. Of the remaining 54 patients, 38 (70.3%) failed NIPPV, among them all 19 patients with shock. In a stepwise logistic regression restricted to patients without shock, metabolic acidosis (odds ratio 1.27, 95% confidence interval (CI) 1.03 to 0.07 per unit of base deficit) and severe hypoxemia (odds ratio 1.03, 95%CI 1.01 to 1.05 per unit decrease in ratio of arterial partial pressure of O(2 )and inspired O(2 )concentration – PaO(2)/FiO(2)) predicted NIPPV failure. In patients who failed NIPPV, the observed mortality was higher than APACHE predicted mortality (68% versus 39%, p < 0.01). CONCLUSION: NIPPV should be tried very cautiously or not at all in patients with ALI who have shock, metabolic acidosis or profound hypoxemia.
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spelling pubmed-15509382006-08-22 Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study Rana, Sameer Jenad, Hussam Gay, Peter C Buck, Curtis F Hubmayr, Rolf D Gajic, Ognjen Crit Care Research INTRODUCTION: The role of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute lung injury (ALI) is controversial. We sought to assess the outcome of ALI that was initially treated with NIPPV and to identify specific risk factors for NIPPV failure. METHODS: In this observational cohort study at the two intensive care units of a tertiary center, we identified consecutive patients with ALI who were initially treated with NIPPV. Data on demographics, APACHE III scores, degree of hypoxemia, ALI risk factors and NIPPV respiratory parameters were recorded. Univariate and multivariate regression analyses were performed to identify risk factors for NIPPV failure. RESULTS: Of 79 consecutive patients who met the inclusion criteria, 23 were excluded because of a do not resuscitate order and two did not give research authorization. Of the remaining 54 patients, 38 (70.3%) failed NIPPV, among them all 19 patients with shock. In a stepwise logistic regression restricted to patients without shock, metabolic acidosis (odds ratio 1.27, 95% confidence interval (CI) 1.03 to 0.07 per unit of base deficit) and severe hypoxemia (odds ratio 1.03, 95%CI 1.01 to 1.05 per unit decrease in ratio of arterial partial pressure of O(2 )and inspired O(2 )concentration – PaO(2)/FiO(2)) predicted NIPPV failure. In patients who failed NIPPV, the observed mortality was higher than APACHE predicted mortality (68% versus 39%, p < 0.01). CONCLUSION: NIPPV should be tried very cautiously or not at all in patients with ALI who have shock, metabolic acidosis or profound hypoxemia. BioMed Central 2006 2006-05-12 /pmc/articles/PMC1550938/ /pubmed/16696863 http://dx.doi.org/10.1186/cc4923 Text en Copyright © 2006 Rana et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Rana, Sameer
Jenad, Hussam
Gay, Peter C
Buck, Curtis F
Hubmayr, Rolf D
Gajic, Ognjen
Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study
title Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study
title_full Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study
title_fullStr Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study
title_full_unstemmed Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study
title_short Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study
title_sort failure of non-invasive ventilation in patients with acute lung injury: observational cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550938/
https://www.ncbi.nlm.nih.gov/pubmed/16696863
http://dx.doi.org/10.1186/cc4923
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