Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study

M. Antonelli, G. Conti, M. Moro, A. Esquinas, G. Gonzalez-Diaz, M. Confalonieri, P. Pelaia, T. Principi, C. Gregoretti, F. Beltrame, M. Pennisi, A. Arcangeli, R. Proietti, M. Passariello, Gianfranco Meduri

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Abstract

Context: In patients with hypoxemic acute respiratory failure (ARF), randomized studies have shown noninvasive positive pressure ventilation (NPPV) to be associated with lower rates of endotracheal intubation. In these patients, predictors of NPPV failure are not well characterized. Objective: To investigate variables predictive of NPPV failure in patients with hypoxemic ARF. Design: Prospective, multicenter cohort study. Setting: Eight Intensive Care Units (ICU) in Europe and USA. Patients: Of 5,847 patients admitted between October 1996 and December 1998, 2,770 met criteria for hypoxemic ARF. Of these, 2,416 were already intubated and 354 were eligible for the study. Results: NPPV failed in 30% (108/354) of patients. The highest intubation rate was observed in patients with ARDS (51%) or community-acquired pneumonia (50%). The lowest intubation rate was observed in patients with cardiogenic pulmonary edema (10%) and pulmonary contusion (18%). Multivariate analysis identified age > 40 years (OR 1.72, 95% CI 0.92-3.23), a simplified acute physiologic score (SAPS II) ≥35 (OR 1.81, 95% CI 1.07-3.06), the presence of ARDS or community-acquired pneumonia (OR 3.75, 95% CI 2.25-6.24), and a PaO2:FiO2 ≤146 after 1 h of NPPV (OR 2.51, 95% CI 1.45-4.35) as factors independently associated with failure of NPPV. Patients requiring intubation had a longer duration of ICU stay (P < 0.001), higher rates of ventilator-associated pneumonia and septic complications (P < 0.001), and a higher ICU mortality (P < 0.001). Conclusions: In hypoxemic ARF, NPPV can be successful in selected populations. When patients have a higher severity score, an older age, ARDS or pneumonia, or fail to improve after 1 h of treatment, the risk of failure is higher.

Original languageEnglish (US)
Pages (from-to)1718-1728
Number of pages11
JournalIntensive Care Medicine
Volume27
Issue number11
DOIs
StatePublished - Dec 27 2001

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Positive-Pressure Respiration
Respiratory Insufficiency
Intubation
Intensive Care Units
Pneumonia
Ventilator-Associated Pneumonia
Intratracheal Intubation
Contusions
Pulmonary Edema
Treatment Failure
Multicenter Studies
Cohort Studies
Multivariate Analysis
Lung

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure : A multi-center study. / Antonelli, M.; Conti, G.; Moro, M.; Esquinas, A.; Gonzalez-Diaz, G.; Confalonieri, M.; Pelaia, P.; Principi, T.; Gregoretti, C.; Beltrame, F.; Pennisi, M.; Arcangeli, A.; Proietti, R.; Passariello, M.; Meduri, Gianfranco.

In: Intensive Care Medicine, Vol. 27, No. 11, 27.12.2001, p. 1718-1728.

Research output: Contribution to journalArticle

Antonelli, M, Conti, G, Moro, M, Esquinas, A, Gonzalez-Diaz, G, Confalonieri, M, Pelaia, P, Principi, T, Gregoretti, C, Beltrame, F, Pennisi, M, Arcangeli, A, Proietti, R, Passariello, M & Meduri, G 2001, 'Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study', Intensive Care Medicine, vol. 27, no. 11, pp. 1718-1728. https://doi.org/10.1007/s00134-001-1114-4
Antonelli, M. ; Conti, G. ; Moro, M. ; Esquinas, A. ; Gonzalez-Diaz, G. ; Confalonieri, M. ; Pelaia, P. ; Principi, T. ; Gregoretti, C. ; Beltrame, F. ; Pennisi, M. ; Arcangeli, A. ; Proietti, R. ; Passariello, M. ; Meduri, Gianfranco. / Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure : A multi-center study. In: Intensive Care Medicine. 2001 ; Vol. 27, No. 11. pp. 1718-1728.
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abstract = "Context: In patients with hypoxemic acute respiratory failure (ARF), randomized studies have shown noninvasive positive pressure ventilation (NPPV) to be associated with lower rates of endotracheal intubation. In these patients, predictors of NPPV failure are not well characterized. Objective: To investigate variables predictive of NPPV failure in patients with hypoxemic ARF. Design: Prospective, multicenter cohort study. Setting: Eight Intensive Care Units (ICU) in Europe and USA. Patients: Of 5,847 patients admitted between October 1996 and December 1998, 2,770 met criteria for hypoxemic ARF. Of these, 2,416 were already intubated and 354 were eligible for the study. Results: NPPV failed in 30{\%} (108/354) of patients. The highest intubation rate was observed in patients with ARDS (51{\%}) or community-acquired pneumonia (50{\%}). The lowest intubation rate was observed in patients with cardiogenic pulmonary edema (10{\%}) and pulmonary contusion (18{\%}). Multivariate analysis identified age > 40 years (OR 1.72, 95{\%} CI 0.92-3.23), a simplified acute physiologic score (SAPS II) ≥35 (OR 1.81, 95{\%} CI 1.07-3.06), the presence of ARDS or community-acquired pneumonia (OR 3.75, 95{\%} CI 2.25-6.24), and a PaO2:FiO2 ≤146 after 1 h of NPPV (OR 2.51, 95{\%} CI 1.45-4.35) as factors independently associated with failure of NPPV. Patients requiring intubation had a longer duration of ICU stay (P < 0.001), higher rates of ventilator-associated pneumonia and septic complications (P < 0.001), and a higher ICU mortality (P < 0.001). Conclusions: In hypoxemic ARF, NPPV can be successful in selected populations. When patients have a higher severity score, an older age, ARDS or pneumonia, or fail to improve after 1 h of treatment, the risk of failure is higher.",
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T1 - Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure

T2 - A multi-center study

AU - Antonelli, M.

AU - Conti, G.

AU - Moro, M.

AU - Esquinas, A.

AU - Gonzalez-Diaz, G.

AU - Confalonieri, M.

AU - Pelaia, P.

AU - Principi, T.

AU - Gregoretti, C.

AU - Beltrame, F.

AU - Pennisi, M.

AU - Arcangeli, A.

AU - Proietti, R.

AU - Passariello, M.

AU - Meduri, Gianfranco

PY - 2001/12/27

Y1 - 2001/12/27

N2 - Context: In patients with hypoxemic acute respiratory failure (ARF), randomized studies have shown noninvasive positive pressure ventilation (NPPV) to be associated with lower rates of endotracheal intubation. In these patients, predictors of NPPV failure are not well characterized. Objective: To investigate variables predictive of NPPV failure in patients with hypoxemic ARF. Design: Prospective, multicenter cohort study. Setting: Eight Intensive Care Units (ICU) in Europe and USA. Patients: Of 5,847 patients admitted between October 1996 and December 1998, 2,770 met criteria for hypoxemic ARF. Of these, 2,416 were already intubated and 354 were eligible for the study. Results: NPPV failed in 30% (108/354) of patients. The highest intubation rate was observed in patients with ARDS (51%) or community-acquired pneumonia (50%). The lowest intubation rate was observed in patients with cardiogenic pulmonary edema (10%) and pulmonary contusion (18%). Multivariate analysis identified age > 40 years (OR 1.72, 95% CI 0.92-3.23), a simplified acute physiologic score (SAPS II) ≥35 (OR 1.81, 95% CI 1.07-3.06), the presence of ARDS or community-acquired pneumonia (OR 3.75, 95% CI 2.25-6.24), and a PaO2:FiO2 ≤146 after 1 h of NPPV (OR 2.51, 95% CI 1.45-4.35) as factors independently associated with failure of NPPV. Patients requiring intubation had a longer duration of ICU stay (P < 0.001), higher rates of ventilator-associated pneumonia and septic complications (P < 0.001), and a higher ICU mortality (P < 0.001). Conclusions: In hypoxemic ARF, NPPV can be successful in selected populations. When patients have a higher severity score, an older age, ARDS or pneumonia, or fail to improve after 1 h of treatment, the risk of failure is higher.

AB - Context: In patients with hypoxemic acute respiratory failure (ARF), randomized studies have shown noninvasive positive pressure ventilation (NPPV) to be associated with lower rates of endotracheal intubation. In these patients, predictors of NPPV failure are not well characterized. Objective: To investigate variables predictive of NPPV failure in patients with hypoxemic ARF. Design: Prospective, multicenter cohort study. Setting: Eight Intensive Care Units (ICU) in Europe and USA. Patients: Of 5,847 patients admitted between October 1996 and December 1998, 2,770 met criteria for hypoxemic ARF. Of these, 2,416 were already intubated and 354 were eligible for the study. Results: NPPV failed in 30% (108/354) of patients. The highest intubation rate was observed in patients with ARDS (51%) or community-acquired pneumonia (50%). The lowest intubation rate was observed in patients with cardiogenic pulmonary edema (10%) and pulmonary contusion (18%). Multivariate analysis identified age > 40 years (OR 1.72, 95% CI 0.92-3.23), a simplified acute physiologic score (SAPS II) ≥35 (OR 1.81, 95% CI 1.07-3.06), the presence of ARDS or community-acquired pneumonia (OR 3.75, 95% CI 2.25-6.24), and a PaO2:FiO2 ≤146 after 1 h of NPPV (OR 2.51, 95% CI 1.45-4.35) as factors independently associated with failure of NPPV. Patients requiring intubation had a longer duration of ICU stay (P < 0.001), higher rates of ventilator-associated pneumonia and septic complications (P < 0.001), and a higher ICU mortality (P < 0.001). Conclusions: In hypoxemic ARF, NPPV can be successful in selected populations. When patients have a higher severity score, an older age, ARDS or pneumonia, or fail to improve after 1 h of treatment, the risk of failure is higher.

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