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Clinical application of noninvasive ventilation in acute respiratory failure in a general ICU

Introduction

Noninvasive ventilation (NIV) is an option in patients with acute respiratory failure [13]. However, NIV complications and failure are not yet completely understood [1, 2]. Our objective was to evaluate the indications, complications and failure of NIV in an adult general ICU.

Methods

From 1 August to 27 October we analyzed prospectively all patients admitted to a 40-bed clinical–surgical ICU of a tertiary care hospital. From those patients, we included the ones who received NIV (total face mask coupled to a BIPAP Vision® or Synchrony®) and evaluated the indications, causes of failure and the complications of this ventilatory support.

Results

During the study period, 465 patients were admitted to the ICU; 111 patients (23.9%) received NIV. The main indications for NIV were: hypoxemic respiratory failure in 22 patients (19.8%), respiratory infection in 19 (17.1%), acute COPD in 14 (12.6%), as part of a weaning strategy in 16 (14.4%), cardiogenic pulmonary edema in 15 (13.5%), ALI/ARDS in nine (8.1%), palliative care in six (5.4%), neuromuscular disease in one (0.9%) and others in nine patients (8.1%). NIV did not avoid intubation in 31 patients (27.9%). The main reasons for failure were: progressive acute respiratory failure in 23 patients (71.9%) and neurological deterioration in five patients (15.6%). NIV was used after extubation in 16 patients, and in five of them (31%) it was necessary reintubation. The only complication observed was gastric insufflation in six patients (5.4%).

Conclusion

NIV is frequently used in a general ICU and the main indication is acute hypoxemic respiratory failure. The NIV failure incidence was significant but similar to the medical literature.

References

  1. 1.

    Demoule A, et al.: Benefits and risk of success or failure of noninvasive ventilation. Intensive Care Med 2006, 32: 1756-1765. 10.1007/s00134-006-0324-1

  2. 2.

    Celikel T, et al.: Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 1998, 114: 1636-1642. 10.1378/chest.114.6.1636

  3. 3.

    Wysocki M, et al.: Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. Chest 1995, 107: 761-768. 10.1378/chest.107.3.761

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Keywords

  • Palliative Care
  • Respiratory Failure
  • Pulmonary Edema
  • Acute Respiratory Failure
  • Main Indication