A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome

Massimo Antonelli, Giorgio Conti, Antonio Esquinas, Luca Montini, Salvatore Maurizio Maggiore, Giuseppe Bello, Monica Rocco, Riccardo Maviglia, Mariano Alberto Pennisi, Gumersindo Gonzalez-Diaz, Gianfranco Meduri

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: In randomized studies of heterogeneous patients with hypoxemic acute respiratory failure, noninvasive positive pressure ventilation (NPPV) was associated with a significant reduction in endotracheal intubation. The role of NPPV in patients with acute respiratory distress syndrome (ARDS) is still unclear. The objective was to investigate the application of NPPV as a first-line intervention in patients with early ARDS, describing what happens in everyday clinical practice in centers having expertise with NPPV. DESIGN: Prospective, multiple-center cohort study. SETTING: Three European intensive care units having expertise with NPPV. PATIENTS: Between March 2002 and April 2004, 479 patients with ARDS were admitted to the intensive care units. Three hundred and thirty-two ARDS patients were already intubated, so 147 were eligible for the study. INTERVENTIONS: Application of NPPV. MEASUREMENTS AND MAIN RESULTS: NPPV improved gas exchange and avoided intubation in 79 patients (54%). Avoidance of intubation was associated with less ventilator-associated pneumonia (2% vs. 20%; p < .001) and a lower intensive care unit mortality rate (6% vs. 53%; p < .001). Intubation was more likely in patients who were older (p = .02), had a higher Simplified Acute Physiology Score (SAPS) II (p < .001), or needed a higher level of positive end-expiratory pressure (p = .03) and pressure support ventilation (p = .02). Only SAPS II >34 and a Pao2/Fio2 ≤175 after 1 hr of NPPV were independently associated with NPPV failure and need for endotracheal intubation. CONCLUSIONS: In expert centers, NPPV applied as first-line intervention in ARDS avoided intubation in 54% of treated patients. A SAPS II >34 and the inability to improve Pao2/Fio2 after 1 hr of NPPV were predictors of failure.

Original languageEnglish (US)
Pages (from-to)18-25
Number of pages8
JournalCritical care medicine
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2007

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Noninvasive Ventilation
Positive-Pressure Respiration
Adult Respiratory Distress Syndrome
Intubation
Intratracheal Intubation
Intensive Care Units
Surveys and Questionnaires
Ventilator-Associated Pneumonia
Respiratory Insufficiency
Cohort Studies
Gases

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. / Antonelli, Massimo; Conti, Giorgio; Esquinas, Antonio; Montini, Luca; Maggiore, Salvatore Maurizio; Bello, Giuseppe; Rocco, Monica; Maviglia, Riccardo; Pennisi, Mariano Alberto; Gonzalez-Diaz, Gumersindo; Meduri, Gianfranco.

In: Critical care medicine, Vol. 35, No. 1, 01.01.2007, p. 18-25.

Research output: Contribution to journalArticle

Antonelli, M, Conti, G, Esquinas, A, Montini, L, Maggiore, SM, Bello, G, Rocco, M, Maviglia, R, Pennisi, MA, Gonzalez-Diaz, G & Meduri, G 2007, 'A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome', Critical care medicine, vol. 35, no. 1, pp. 18-25. https://doi.org/10.1097/01.CCM.0000251821.44259.F3
Antonelli, Massimo ; Conti, Giorgio ; Esquinas, Antonio ; Montini, Luca ; Maggiore, Salvatore Maurizio ; Bello, Giuseppe ; Rocco, Monica ; Maviglia, Riccardo ; Pennisi, Mariano Alberto ; Gonzalez-Diaz, Gumersindo ; Meduri, Gianfranco. / A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. In: Critical care medicine. 2007 ; Vol. 35, No. 1. pp. 18-25.
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AU - Antonelli, Massimo

AU - Conti, Giorgio

AU - Esquinas, Antonio

AU - Montini, Luca

AU - Maggiore, Salvatore Maurizio

AU - Bello, Giuseppe

AU - Rocco, Monica

AU - Maviglia, Riccardo

AU - Pennisi, Mariano Alberto

AU - Gonzalez-Diaz, Gumersindo

AU - Meduri, Gianfranco

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N2 - OBJECTIVE: In randomized studies of heterogeneous patients with hypoxemic acute respiratory failure, noninvasive positive pressure ventilation (NPPV) was associated with a significant reduction in endotracheal intubation. The role of NPPV in patients with acute respiratory distress syndrome (ARDS) is still unclear. The objective was to investigate the application of NPPV as a first-line intervention in patients with early ARDS, describing what happens in everyday clinical practice in centers having expertise with NPPV. DESIGN: Prospective, multiple-center cohort study. SETTING: Three European intensive care units having expertise with NPPV. PATIENTS: Between March 2002 and April 2004, 479 patients with ARDS were admitted to the intensive care units. Three hundred and thirty-two ARDS patients were already intubated, so 147 were eligible for the study. INTERVENTIONS: Application of NPPV. MEASUREMENTS AND MAIN RESULTS: NPPV improved gas exchange and avoided intubation in 79 patients (54%). Avoidance of intubation was associated with less ventilator-associated pneumonia (2% vs. 20%; p < .001) and a lower intensive care unit mortality rate (6% vs. 53%; p < .001). Intubation was more likely in patients who were older (p = .02), had a higher Simplified Acute Physiology Score (SAPS) II (p < .001), or needed a higher level of positive end-expiratory pressure (p = .03) and pressure support ventilation (p = .02). Only SAPS II >34 and a Pao2/Fio2 ≤175 after 1 hr of NPPV were independently associated with NPPV failure and need for endotracheal intubation. CONCLUSIONS: In expert centers, NPPV applied as first-line intervention in ARDS avoided intubation in 54% of treated patients. A SAPS II >34 and the inability to improve Pao2/Fio2 after 1 hr of NPPV were predictors of failure.

AB - OBJECTIVE: In randomized studies of heterogeneous patients with hypoxemic acute respiratory failure, noninvasive positive pressure ventilation (NPPV) was associated with a significant reduction in endotracheal intubation. The role of NPPV in patients with acute respiratory distress syndrome (ARDS) is still unclear. The objective was to investigate the application of NPPV as a first-line intervention in patients with early ARDS, describing what happens in everyday clinical practice in centers having expertise with NPPV. DESIGN: Prospective, multiple-center cohort study. SETTING: Three European intensive care units having expertise with NPPV. PATIENTS: Between March 2002 and April 2004, 479 patients with ARDS were admitted to the intensive care units. Three hundred and thirty-two ARDS patients were already intubated, so 147 were eligible for the study. INTERVENTIONS: Application of NPPV. MEASUREMENTS AND MAIN RESULTS: NPPV improved gas exchange and avoided intubation in 79 patients (54%). Avoidance of intubation was associated with less ventilator-associated pneumonia (2% vs. 20%; p < .001) and a lower intensive care unit mortality rate (6% vs. 53%; p < .001). Intubation was more likely in patients who were older (p = .02), had a higher Simplified Acute Physiology Score (SAPS) II (p < .001), or needed a higher level of positive end-expiratory pressure (p = .03) and pressure support ventilation (p = .02). Only SAPS II >34 and a Pao2/Fio2 ≤175 after 1 hr of NPPV were independently associated with NPPV failure and need for endotracheal intubation. CONCLUSIONS: In expert centers, NPPV applied as first-line intervention in ARDS avoided intubation in 54% of treated patients. A SAPS II >34 and the inability to improve Pao2/Fio2 after 1 hr of NPPV were predictors of failure.

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