scholarly journals Risk factors for non-invasive ventilation failure in influenza infection with acute respiratory failure in emergency department

2020 ◽  
Author(s):  
Karn Suttapanit ◽  
Jeeranun Boriboon ◽  
Pitsucha Sanguanwit
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Influenza Infection ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Ventilation Failure

scholarly journals Risk Factors for Non-invasive Ventilation Failure in Influenza Infection with Acute Respiratory Failure in Emergency Department

2020 ◽  
Author(s):  
Karn Suttapanit ◽  
Jeeranun Boriboon ◽  
Pitsucha Sanguanwit
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Sofa Score ◽  
Chest Radiography ◽  
Influenza Infection ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract BackgroundNon-invasive ventilation (NIV) has been widely used in hypoxemic acute respiratory failure (ARF) due to influenza pneumonia in emergency department (ED). However, the benefit of NIV in decreasing intubation rate remains controversial. Previous studies have reported that prolonged use of NIV was associated with increased mortality. Our study aims to identify risk factors for NIV failure in influenza infection with acute respiratory failure in ED.MethodWe perform a retrospective cohort observational study. Enrolled patients older than 18 years who used NIV due to influenza infection with ARF between 1 January 2017 to 31 December 2018 in Ramathibodi Emergency Department. Patients characteristics, comorbidity, clinical and laboratory outcome, chest imaging, NIV setting and parameter were recorded. We follow the outcome success or failure of the NIV used.Results162 patients were enrolled, 72 (44%) suffered NIV failure in influenza infection with ARF. We used univariate and multivariate logistic analyses to assess risk factors for NIV failure. The ability of risk factor to predict NIV failure was analyzed using the area under the receiver operating characteristic (AUROC). Risk factors of NIV failure included sequential organ failure assessment (SOFA) score (P = 0.001), PaO2/FiO2 (PF) ratio (P = 0.001) and quadrant infiltrations in chest x-rays (CXR) (P = 0.001). SOFA score, PF ratio and number quadrant infiltrations in chest radiography have good ability to predict NIV failure, AUROC 0.894 (0.839 - 0.948), 0.828 (0.764 - 0.892) and 0.792 (0.721 – 0.863), respectively and no significant difference in the ability to predict NIV failure between three parameters. Use of PF ratio plus number quadrant infiltrations in chest radiography demonstrated higher predictive ability for NIV failure in influenza infection with ARF.ConclusionsSOFA score, PF ratio and quadrant infiltrations in chest radiography were good predictors of NIV failure in influenza infection with ARF.

scholarly journals Non-invasive ventilation in acute respiratory failure in children

2012 ◽  
Vol 4 (2) ◽  
pp. 16 ◽  
Author(s):  
Clara Abadesso ◽  
Pedro Nunes ◽  
Catarina Silvestre ◽  
Ester Matias ◽  
Helena Loureiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Odds Ratio ◽  
Prospective Clinical Study ◽  
Invasive Ventilation ◽  
Failure Group ◽  
Non Invasive ◽  
Non Invasive Ventilation

The aim of this paper is to assess the clinical efficacy of non-invasive ventilation (NIV) in avoiding endotracheal intubation (ETI), to demonstrate clinical and gasometric improvement and to identify predictive risk factors associated with NIV failure. An observational prospective clinical study was carried out. Included Patients with acute respiratory disease (ARD) treated with NIV, from November 2006 to January 2010 in a Pediatric Intensive Care Unit (PICU). NIV was used in 151 patients with acute respiratory failure (ARF). Patients were divided in two groups: NIV success and NIV failure, if ETI was required. Mean age was 7.2±20.3 months (median: 1 min: 0,3 max.: 156). Main diagnoses were bronchiolitis in 102 (67.5%), and pneumonia in 44 (29%) patients. There was a significant improvement in respiratory rate (RR), heart rate (HR), pH, and pCO2 at 2, 6, 12 and 24 hours after NIV onset (P<0.05) in both groups. Improvement in pulse oximetric saturation/ fraction of inspired oxygen (SpO2/FiO2) was verified at 2, 4, 6, 12 and 24 hours after NIV onset in the success group (P<0.001). In the failure group, significant SpO2/FiO2 improvement was only observed in the first 4 hours. NIV failure occurred in 34 patients (22.5%). Risk factors for NIV failure were apnea, prematurity, pneumonia, and bacterial co-infection (P<0.05). Independent risk factors for NIV failure were apneia (P<0.001; odds ratio 15.8; 95% confidence interval: 3.42-71.4) and pneumonia (P<0.001, odds ratio 31.25; 95% confidence interval: 8.33-111.11). There were no major complications related with NIV. In conclusion this study demonstrates the efficacy of NIV as a form of respiratory support for children and infants with ARF, preventing clinical deterioration and avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection.

scholarly journals Effectiveness and applicability of Non-Invasive Ventilation (NIV) in the Emergency Department in acute respiratory failure due to Sars-CoV-2 pneumonia

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Federico Lari ◽  
Fabrizio Giostra ◽  
Stefania Guerrini
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
De Novo ◽  
Correct Identification ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Radiological Features ◽  
Non Invasive Ventilation ◽  
Hypoxic Respiratory Failure

Treatment of de novo acute hypoxic respiratory failure is not recommended by current Non-Invasive Ventilation (NIV) guidelines as it does not seem to improve patients outcome. Many cases of acute hypoxic respiratory failure associated with Sars-Cov2 infection (SARI) have been observed during Sars-Cov2 pandemic. So far, data are missing regarding the use of NIV, but a correct identification of subgroups of patients based on different clinical, patho-physiological and radiological features, might be helpful for stratifying patients and choosing the correct respiratory support (invasive versus non-invasive). In case of NIV appliance, risk of environmental virus dispersion is particularly elevated; therefore, extreme attention by operators is required.

scholarly journals Non-Invasive Ventilation in the Elderly at Emergency Department: Epidemiological Data and Results

2020 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Elderly People ◽  
Tertiary Care ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Hospital Data ◽  
Non Invasive ◽  
Non Invasive Ventilation

Introduction: Non-invasive ventilation (NIV) could be a good alternative in elderly people with acute respiratory failure (ARF), to procure them a respiratory support while avoiding as much as possible the complications of invasive ventilation. Methods: This is an observational retrospective study conducted at the emergency department (ED) of a tertiary care, university-based teaching hospital. Data of elderly patients (≥ 65 years) admitted to ED between January 2017 and April 2018 for ARF and requiring NIV were collected and analyzed using SPSS 22 software. Results: Sixty six patients (≥ 65 years) requiring NIV for acute respiratory failure (ARF) were included. The mean age was 76 years (± 7), the median Charlson index was 5. Acute respiratory failure was related to acute heart failure in 68%, acute exacerbation of chronic obstructive pulmonary disease in 53% and pneumonia in 39% of cases. Forty eight percent had more than one etiologic diagnosis. Hypercapnic acute respiratory failure was observed in 61%. On initiation of NIV, the average pH was 7.31 (± 0.11) and PaCO2 56 mmHg (± 21), After NIV, the average pH was 7.38 (± 0.11) and PaCO2 53 mmHg (± 26). Improvement of pH was significant (p < 0.05). 61% of patients were discharged at home, 9% were admitted to intensive care unit. Invasive ventilation was performed in 4%, of which 23% died. Success of NIV was observed in 68% of patients. Conclusion: NIV can be of a great interest in elderly people. Our study showed that it can be used successfully in the studied settings.

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

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