Incidence of and risk factors for nonrespiratory acute organ failure in ICU patients receiving respiratory support: a pilot international cohort study

Introduction

Strategies to prevent the progression to nonrespiratory multiorgan failure (nrAOF) in patients receiving invasive or non-invasive ventilation are needed. We performed a pilot international prospective cohort study to determine the incidence of and risk for nrAOF in ICU patients receiving respiratory support.

Methods

All consecutive ICU admissions to 11 ICUs (UK, Australia and Canada) were screened during the first 24 hours over a 4-week period. Patients receiving positive pressure ventilatory support for at least 1 hour during the first 24 hours were eligible. Those with nrAOF (SOFA 3 to 4), or elective postsurgical patients extubated and ready for discharge within 24 hours after admission, were excluded. Follow up lasted for the first of 14 days after enrolment or ICU discharge.

Results

In total, 123/766 (16.1%) patients were enrolled. Elective postsurgery ventilation (22.1%) and type I respiratory failure (29.5%) were the most frequent indications for respiratory support. n = 49 (39.8%, 95% CI = 31.1 to 48.6%) developed nrAOF after an average 3.7 (SD 1.5) days. The 28-day ICU mortality was 8.1%. In univariate analysis, APACHE II >14.5 (OR = 3.0, 95% CI = 1.2 to 7.1) and nonrespiratory SOFA score >1 (OR = 2.3, 95% CI = 1.1 to 4.7 excluding GCS) were associated (P < 0.05) with AOF. See Table 1.

Table 1

Conclusions

Nearly 4/10 developed AOF, but the treatment window is relatively small. APACHE II and baseline SOFA may predict risk. These data inform future trials of preventive strategies but a study with more outcome events is needed to reduce the confidence intervals.