Epidemiology of noninvasive mechanical ventilation in acute respiratory failure - a retrospective population-based study

BMC Emergency Medicine

Research Article

Balwinder Singh¹  Michelle Biehl¹  Ivaylo L Krastev¹  Marija Kojicic²  Shihan Wang³  Guangxi Li³  Lin Tian³ 

[1] Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA;Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA;Department of Medicine, The Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Sremska Kamenica, Serbia;Department of Medicine, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China;Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA;

关键词: Noninvasive mechanical ventilation;    Acute respiratory failure;    Epidemiology;    Olmsted county;    Health care delivery;   

DOI  :  10.1186/1471-227X-13-6

 received in 2012-08-13, accepted in 2013-04-05,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundNoninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study.MethodsWe conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (≥18 years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded.ResultsOut of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 60–84), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment.ConclusionsOur results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment.

【 授权许可】

Unknown   
© Wang et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.