The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting (original) (raw)
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Intensive Care Medicine, 2007
Objective: Randomized clinical trials demonstrating benefits of noninvasive ventilation (NIV) systematically exclude patients with "do-not-intubate" (DNI) orders, but in daily clinical practice these patients are frequently treated with NIV. A recent North American study found a 43% hospital survival rate in patients with DNI orders. Our hypothesis was that, due to the very different social and cultural setting, written DNI orders in a southern European country would be restricted to a population with a poor outcome, independently of whether they receive NIV, and we analyzed hospital survival in patients receiving NIV and the impact of DNI orders on survival. Design and setting: Retrospective cohort study in a general ICU in a university-affiliated hospital. Patients and methods: All 233 patients treated with NIV during 2002-2004. We recorded clinical characteristics on admission, mortality risk by APACHE II and ICU and hospital outcome, and 6-month outcome. Results: Hospital survival was 66%. Survival was better in the 199 patients without DNI orders than in the 36 with DNI orders both during hospitalization (74% vs. 26%, OR 7.9) and after 6 months (64% vs. 15%, OR 10.2). In both groups the presence of COPD was associated with better prognosis during hospitalization, but not in the medium-term. Conclusion: Our study suggests that NIV offers low expectations for medium-term survival in DNI patients.
Respiratory medicine, 2009
Trial of noninvasive ventilation (NIV) in the emergency department (ED) for heterogeneous acute respiratory failure (ARF) has been optional and its clinical benefit unclear. We conducted a retrospective cohort study comparing between two periods, October 2001-September 2003 and October 2004-September 2006, i.e., before and after adopting an NIV-trial strategy in which NIV was applied in the ED to any noncontraindicated ARF patients needing ventilatory support and was then continued in the intermediate-care-unit. During these two periods, we retrieved cases of ARF treated either invasively or with NIV, and compared the patients' in-hospital mortalities and the length of ICU and intermediate-care-unit stay. Compared were 73 (invasive 56, NIV 17) and 125 cases (invasive 31, NIV 94) retrieved from 271 and 415 emergent admissions with proper pulmonary etiologies for mechanical ventilation, respectively. Of their respiratory failures, type (hypercapnic/non-hypercapnic, 0.97 vs. 0.98) ...
Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards
Respiratory Care, 2013
BACKGROUND: Initiation of noninvasive ventilation (NIV) on the wards is not universally accepted. Medical emergency teams (METs) provide acute care and monitoring to deteriorating patients on the general wards. Whether it is safe for an MET to start NIV in ward patients with respiratory distress remains unclear. METHODS: We evaluated 1,123 MET calls in 30,217 ward patients between January 2009 and June 2011 from the prospectively maintained MET database in our tertiary care hospital. We identified ward patients with acute desaturation (< 90%) and tachypnea (breathing frequency > 28 breaths/min), for whom an MET was called. Subjects transferred to the ICU at the end of an MET call were excluded. The remaining ward subjects were divided into 2 groups: patients who were not started on NIV by the MET; versus patients who were started on NIV by the MET. The primary outcome was endotracheal intubation or ICU transfer within 48 hours of MET activation. Secondary outcome measures were 28-day mortality and ICU mortality. RESULTS: Two hundred thirty-eight MET subjects met the study criteria, and 109 immediate ICU transfers were excluded. Of the remaining 129 ward subjects, 54 were in the NIV group, and 75 in the no-NIV group. The NIV group subjects were sicker (mean Acute Physiology and Chronic Health Evaluation II score 17.6 ؎ 5.1 versus 14.4 ؎ 5, P < .001). Subjects with pulmonary edema, COPD exacerbation, or asthma exacerbation were more likely, while those with pneumonia were less likely to be placed on NIV. The primary outcome was reached in 2/54 (3.7%) of the NIV subjects and 12/75 (16%) of the no-NIV subjects (P ؍ .03). There was no significant difference (P > .30) between the groups in 28-day mortality (7.4% vs 13.3%) or ICU mortality (3.7% vs 8%). CONCLUSIONS: In selected ward patients, especially those with COPD or pulmonary edema, NIV can be safely initiated by an MET.
Impact of noninvasive ventilation failure upon patient prognosis. Subanalysis of a multicenter study
Medicina Intensiva (English Edition), 2012
Objective: Noninvasive ventilation (NIV) constitutes first-line treatment for the exacerbation of obstructive pulmonary disease and cardiogenic lung edema. Several studies suggest that NIV failure could increase the risk of mortality, mainly due to the delay in tracheal intubation. We aimed to evaluate the negative impact of NIV failure in routine practice among Spanish ICUs. Patients: A subanalysis was made of the multicenter validation of the Sabadell Score study, extracting patients with acute respiratory failure requiring either invasive or noninvasive mechanical ventilation, with the exclusion of patients presenting ''do not resuscitate and/or do not intubate'' orders. Variables: We recorded demographic parameters, ICU-specific treatments and the development of acute renal failure or infections during ICU stay. Patients were followed-up on until hospital discharge or death. The statistic analysis included Cox multiple logistic regression. Results: We analyzed 4132 patients, of whom 1602 (39%) received only invasive mechanical ventilation (IMV), while 529 (13%) received NIV. The latter succeeded in 50% of the patients, but ଝ Please cite this article as: Delgado M, et al. Impacto del fracaso de la ventilacion no invasiva en el pronóstico de los pacientes. Subanálisis de un estudio multicéntrico. Med Intensiva.
Panacea Journal of Medical Sciences, 2023
Abstract Background: Failure of respiratory system in one or both of its gas-exchanging functions- oxygenation of pulmonary arterial blood and carbon-dioxide elimination from mixed venous blood. Non-Invasive Ventilation is an alternative to invasive ventilation in many conditions it is a valuable component in patient management. Its use in acute respiratory failure is widely accepted and well known. Aim: To Study the indications, outcomes, and complications of NIV. Materials and Methods: This is a prospective observational study conducted on 100 patients admitted with either Type-I or Type -II respiratory failure. Results: Various common indications for use of NIV in acute Respiratory Failure are COPD, ILD, Bronchiectasis, Pneumonia, Pulmonary Thromboembolism, Kyphoscoliosis, and Pulmonary Tuberculosis in that order. The overall success rate of NIV is 84%. Conclusion: NIV helps in improving gas exchange in acute respiratory failure irrespective of its type, reduces intubation and length of hospital stay hence, its use as the first modality of treatment in patients without overt contraindications is recommended. Overall, NIV is safe and effective in patients with acute respiratory failure as there are no major complications associated with its use. Keywords: Respiratory failure, Complications, NonInvasive Ventilation
A Study of Outcome of Noninvasive Ventilatory Support in Acute Respiratory Failure
Indian Journal of Respiratory Care
Respiratory failure is said to exist when there is inadequate gas exchange due to dysfunction of the respiratory system. [1] Ventilatory support is an important treatment component of patients having acute respiratory failure. It can be invasive or noninvasive. To avoid the morbidity associated with endotracheal intubation, noninvasive ventilation (NIV) was developed. NIV has been highly successful in acute respiratory failure caused by a wide spectrum of diseases. NIV decreases work of breathing, improves arterial oxygenation and alveolar ventilation, prevents the use of invasive mechanical ventilation, reduces the incidence of ventilator associated pneumonia, and decreases the length of intensive care unit (ICU) stay and mortality, mainly due to chronic obstructive pulmonary disease (COPD) exacerbations [2,3] and acute cardiogenic pulmonary edema. [4-7] However, NIV is not successful in all patients with acute respiratory failure. NIV has controversial role in respiratory failure due to pneumonia and Acute Respiratory Distress Syndrome (ARDS). [8] Patients on NIV must be monitored closely for signs of treatment failure and should be intubated promptly before a crisis develops. Therefore, there is a need to identify prognostic factors for the outcome of NIV. [9-11] Aim of the study The aim of the study was to assess the outcome of NIV in patients of acute respiratory failure and to determine predictors of positive outcome. PatIents and Methods It was an observational and analytical type of study. A total of 110 patients admitted to our hospital from January 2011 to
Canadian Respiratory Journal, 2015
I n the past two decades, there has been increased interest in the use of noninvasive ventilation (NIV) as a treatment for acute respiratory failure (1-3). NIV can provide ventilatory support with similar physiological benefits as invasive mechanical ventilation, including reduced work of breathing and improved gas exchange (4). NIV has advantages including the need for less sedation, reduced risk for ventilator-associated pneumonia, and shorter durations of ventilation and intensive care unit (ICU) stay (5). Consequently, the use of NIV has increased internationally (6) within ICUs, emergency departments (EDs) (7,8) and postanesthetic care units (9), as well as medical wards and palliative care units (10,11). However, the frequency of NIV use varies among sites and countries (1,2,12-17), and may be underutilized in some diagnoses (18). The quality of evidence supporting the use of NIV in various etiologies of acute respiratory failure varies. A recent Canadian clinical practice guideline (19) highlighted the varying strength of evidence to GC Digby, SP Keenan, CM Parker, et al. Noninvasive ventilation practice patterns for acute respiratory failure in Canadian tertiary care centres: A descriptive analysis.
Non-invasive ventilation for acute hypoxaemic respiratory failure: a propensity-matched cohort study
BMJ Open Respiratory Research, 2022
Background Non-invasive ventilation (NIV), although effective in treating hypercapnic respiratory failure, has not demonstrated the same efficacy in treating acute hypoxaemic respiratory failure. We aimed to examine the effect of NIV use on ventilator-free days in patients with acute hypoxaemic respiratory failure admitted to the intensive care unit (ICU). Methods We conducted a retrospective study of patients admitted to the ICU with acute hypoxaemic respiratory failure at Waikato Hospital, New Zealand, from 1 January 2009 to 31 December 2018. Patients treated with NIV as the initial oxygenation strategy were compared with controls treated with early intubation. The two groups were matched using a propensity score based on baseline characteristics. The primary outcome was the number of ventilator-free days at day 28. The secondary outcomes were ICU and hospital length of stay and in-hospital mortality. Results Out of 175 eligible patients, 79 each out of the NIV and early intubation groups were matched using a propensity score. Early NIV was associated with significantly higher median ventilator-free days than early intubation (17 days vs 23 days, p=0.013). There was no significant difference in median ICU length of stay (112.5 hours vs 117.7 hours), hospital length of stay (14 days vs 14 days) or in-hospital mortality (31.6% vs 37.9%) between the NIV and the early intubation group. Conclusion Compared with early intubation, NIV use was associated with more ventilator-free days in patients with hypoxaemic respiratory failure. However, this did not translate into a shorter length of stay or reduced mortality based on our single-centre experience.