Skip to Main content Skip to Navigation
Journal articles

Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors.

Abstract : INTRODUCTION: We assessed rates and predictive factors of non-invasive ventilation (NIV) failure in patients admitted to the intensive care unit (ICU) for non-hypercapnic acute hypoxemic respiratory failure (AHRF). METHODS: This is an observational cohort study using data prospectively collected over a three-year period in a medical ICU of a university hospital. RESULTS: Among 113 patients receiving NIV for AHRF, 82 had acute respiratory distress syndrome (ARDS) and 31 had non-ARDS. Intubation rates significantly differed between ARDS and non-ARDS patients (61% versus 35%, P = 0.015) and according to clinical severity of ARDS: 31% in mild, 62% in moderate, and 84% in severe ARDS (P = 0.0016). In-ICU mortality rates were 13% in non-ARDS, and, respectively, 19%, 32% and 32% in mild, moderate and severe ARDS (P = 0.22). Among patients with moderate ARDS, NIV failure was lower among those having a PaO2/FiO2 >150 mmHg (45% vs. 74%, p = 0.04). NIV failure was associated with active cancer, shock, moderate/severe ARDS, lower Glasgow coma score and lower positive end-expiratory pressure level at NIV initiation. Among intubated patients, ICU mortality rate was 46% overall and did not differ according to the time to intubation. CONCLUSIONS: With intubation rates below 35% in non-ARDS and mild ARDS, NIV stands as the first-line approach; NIV may be attempted in ARDS patients with a PaO2/FiO2 > 150. By contrast, 84% of severe ARDS required intubation and NIV did not appear beneficial in this subset of patients. However, the time to intubation had no influence on mortality.
Complete list of metadatas

Cited literature [25 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-00925322
Contributor : Ed. Bmc <>
Submitted on : Tuesday, January 7, 2014 - 9:09:54 PM
Last modification on : Wednesday, August 19, 2020 - 11:16:40 AM
Long-term archiving on: : Tuesday, April 8, 2014 - 12:25:31 AM

Files

cc13103.pdf
Publisher files allowed on an open archive

Identifiers

Collections

Citation

Arnaud Thille, Damien Contou, Chiara Fragnoli, Ana Córdoba-Izquierdo, Florence Boissier, et al.. Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors.. Critical Care, BioMed Central, 2013, 17 (6), pp.R269. ⟨10.1186/cc13103⟩. ⟨inserm-00925322⟩

Share

Metrics