Is hypocapnia a risk factor for non-invasive ventilation failure in acute heart failure?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Carrillo-Aleman ◽  
A Montenegto Moure ◽  
L Lopez Gomez ◽  
P.S Bayoumi Delis ◽  
A.A Agamez Luengas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Risk Factor ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Acute Heart Failure ◽  
Invasive Ventilation ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract Introduction Non-invasive ventilation (NIV) has become a standard treatment for acute respiratory failure. Multiple factors associated with failure of this ventilatory technique have been described. Some authors postulate that the presence of hypocapnia at the onset of NIV increases the mortality of patients with acute heart failure (AHF). Purpose To analyse whether the presence of hypocapnia is a risk factor for failure of NIV in the patient with AHF. Methods Observational, retrospective study on a prospective database. All patients with AHF admitted to Intensitive Care Unit (ICU) between January 1997 and December 2017 for respiratory failure and requiring NIV are included. The inclusion criteria were the presence of dyspnea, respiratory rate ≥30 and PaO2/FiO2 <250 mmHg. The exclusion criteria were the presence of cardiogenic shock and AHF due to involvement of the right ventricle. Hypocapnia is defined as the presence of PaCO2 <35 mmHg) in basal gasometry prior to NIV, normocapnia as PaCO2 between 35 and 45 mmHg and PaCO2 hypercapnia greater than 45 mmHg. NIV failure is defined as the need for endotracheal intubation or death in ICU. Quantitative variables are expressed as means ± standard deviation, and qualitative variables as percentages. Comparison between variables has been made using the Ji2 linear trend test and single factor ANOVA. Multivariate analysis was performed using logistic regression with the calculation of odds ratios (OR) and their 95% confidence intervals (CI-95%). Results A total of 1009 patients with AHF, 158 (15.7%) normocapnic, 361 (35.8%) hypocapnic and 490 (48.5%) hypercapnic were analyzed. The age in the 3 groups was 73.3±10.4, 73.3±11.2 and 75.6±8.9 years (p=0.001), respectively. In the normocapnic group the respiratory rate was 36±4, PaCO2 40±3 and PaO2/FiO2 125±31. In the hypocapnic group 37±3, 28±3 and 134±30; and in the hypercapnic group 37±6, 65±16 and 126±36, respectively. NIV failure was observed in 15 (9.5%) of normocapnic patients, 56 (15.5%) of hypocapnic patients and 54 (11%) of hypercapnic patients (p=0.070). Independent risk factors for NIV failure were SAPS II (OR=1.07, CI-95%=1.04–1.09), order of non-intubation (OR=2.88, CI-95%=1.45–1.81), baseline SOFA (OR=1.76, CI-95%=1.48–2.08), HACOR index at 1 hour NIV (OR=1,62, CI-95%=1.45–1.08), the presence of acute coronary syndrome (OR=2.18, CI-95%=1.18–4.01), the presence of NIV-related complication (OR=6.42, CI-95%=3.47–11.89) and hypocapnia at the onset of NIV (OR=3.842, CI-95%=2.02–7.27). Conclusions Hypocapnia at the beginning of NIV in the patient with AHF is a frequent finding. Among the risk factors for poor prognosis, the presence of hypocapnia is a strong predictor of NIV failure. Funding Acknowledgement Type of funding source: None

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 PL01: Creation of a risk scoring system for emergency department patients with acute heart failure

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S5-S5
Author(s):  
I. Stiell ◽  
J. Perry ◽  
C. Clement ◽  
S. Sibley ◽  
A. McRae ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients ◽  
Risk Scoring ◽  
Risk Scale

Introduction: Acute heart failure (AHF) is a common emergency department (ED) presentation and may be associated with poor outcomes. Conversely, many patients rapidly improve with ED treatment and may not need hospital admission. Because there is little evidence to guide disposition decisions by ED and admitting physicians, we sought to create a risk score for predicting short-term serious outcomes (SSO) in patients with AHF. Methods: We conducted prospective cohort studies at 9 tertiary care hospital EDs from 2007 to 2019, and enrolled adult patients who required treatment for AHF. Each patient was assessed for standardized real-time clinical and laboratory variables, as well as for SSO (defined as death within 30 days or intubation, non-invasive ventilation (NIV), myocardial infarction, coronary bypass surgery, or new hemodialysis after admission). The fully pre-specified, logistic regression model with 13 predictors (age, pCO2, and SaO2 were modeled using spline functions with 3 knots and heart rate and creatinine with 5 knots) was fitted to the 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions and estimated a sample size of 170 SSOs. Results: The 2,246 patients had mean age 77.4 years, male sex 54.5%, EMS arrival 41.1%, IV NTG 3.1%, ED NIV 5.2%, admission on initial visit 48.6%. Overall there were 174 (7.8%) SSOs including 70 deaths (3.1%). The final risk scale is comprised of five variables (points) and had c-statistic of 0.76 (95% CI: 0.73-0.80): 1.Valvular heart disease (1) 2.ED non-invasive ventilation (2) 3.Creatinine 150-300 (1) ≥300 (2) 4.Troponin 2x-4x URL (1) ≥5x URL (2) 5.Walk test failed (2) The probability of SSO ranged from 2.0% for a total score of 0 to 90.2% for a score of 10, showing good calibration. The model was stable over 1,000 bootstrap samples. Choosing a risk model total point admission threshold of >2 would yield a sensitivity of 80.5% (95% CI 73.9-86.1) for SSO with no change in admissions from current practice (48.6% vs 48.7%). Conclusion: Using a large prospectively collected dataset, we created a concise and sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of this risk scoring scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

scholarly journals Indications and practical approach to non-invasive ventilation in acute heart failure

2017 ◽  
Vol 39 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Josep Masip ◽  
W Frank Peacock ◽  
Susanna Price ◽  
Louise Cullen ◽  
F Javier Martin-Sanchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Practical Approach ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Non-invasive ventilation in acute heart failure

2020 ◽  
Vol 72 ◽  
pp. S23-S24
Author(s):  
Sarda Mukund Shyam ◽  
Darshan Mehra ◽  
R.R. Chaudhary
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals LO02: Development of the HEARTRISK6 Scale for emergency department patients with acute heart failure

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S7
Author(s):  
I. Stiell ◽  
A. McRae ◽  
B. Rowe ◽  
J. Dreyer ◽  
L. Mielniczuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Tertiary Care ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients ◽  
Risk Scale

Introduction: We previously derived (N = 559) and validated (N = 1,100) the 10-item Ottawa Heart Failure Risk Scale (OHFRS), to assist with disposition decisions for patients with acute heart failure (AHF) in the emergency department (ED). In the current study we sought to use a larger dataset to develop a more concise and more accurate risk scale. Methods: We analyzed data from the prior two studies and from a new cohort. For all 3 groups we conducted prospective cohort studies that enrolled patients who required treatment for AHF at 8 tertiary care hospital EDs. Patients were followed for 30 days. The primary outcome was short-term serious outcome (SSO), defined as death within 30 days, intubation or non-invasive ventilation (NIV) after admission, myocardial infarction, or relapse resulting in hospital admission within 14 days. The fully pre-specified logistic regression model with 13 predictors (where age, pCO2, and SaO2 were modeled using spline functions) was fitted to 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions, and estimated a sample size of 2,000 patients. Results: The 1,986 patients had mean age 77.3 years, male 54.1%, EMS arrival 41.2%, IV NTG 3.3%, ED NIV 5.4%, admission on initial visit 49.5%. Overall there were 236 (11.9%) SSOs including 61 deaths (3.1%), meaning that current admission practice sensitivity for SSO was only 59.7%. The final HEARTRISK6 scale is comprised of 6 variables (points) (C-statistic 0.68): Valvular heart disease (2) Antiarrhythmic medication (2) ED non-invasive ventilation (3) Creatinine 80–150 (1); ≥150 (3) Troponin ≥3x URL (2) Walk test failed (1). The probability of SSO ranged from 4.8% for a total score of 0 to 62.4% for a score of 10, showing good calibration. Choosing a HEARTRISK6 total point admission threshold of ≥3 would yield sensitivity of 70.8% (95%CI 64.5-76.5) for SSO with a slight decrease in admissions to 47.9%. Choosing a threshold of ≥2 would yield a sensitivity of 84.3% (95%CI 79.0-88.7) but require 66.6% admissions. Conclusion: Using a large prospectively collected dataset, we created a more concise and more sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of the HEARTRISK6 scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

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.

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