Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital

Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital

Author Yamauchi, Liria Yuri Autor UNIFESP Google Scholar
Travaglia, Teresa Cristina Francischetto Google Scholar
Bernardes, Sidnei Ricardo Nobre Google Scholar
Figueiroa, Maise C. Google Scholar
Tanaka, Clarice Google Scholar
Fu, Carolina Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Abstract OBJECTIVES: To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis. METHODS: A prospective cohort study. RESULTS: Medical disorders (59%) and elective surgery (21%) were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55%) and a decreased level of consciousness (20%). The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5) versus four (3-7) days]; they had lower levels of pH, HCO3 and base excess, and the FiO2 level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26) days vs. 8 (5-14) days], as well as a higher mortality rate (9 vs. 51%). There was an association between failure and mortality, which had an odds ratio (95% CI) of 10.6 (5.93 -19.07). The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II$34, an inspiratory positive airway pressure level > 15 cmH2O and pH<7.40. CONCLUSION: The indications for noninvasive positive-pressure ventilation were quite varied. The failure group had a longer intensive care unit stay and higher mortality. Simplified Acute Physiology Score II > 34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.
Keywords Artificial ventilation
Noninvasive Ventilation
Intensive Care Unit
Cohort Study
Language English
Date 2012-07-01
Published in Clinics. Faculdade de Medicina / USP, v. 67, n. 7, p. 767-772, 2012.
ISSN 1807-5932 (Sherpa/Romeo, impact factor)
Publisher Faculdade de Medicina / USP
Extent 767-772
Origin http://dx.doi.org/10.6061/clinics/2012(07)11
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000307723100011
SciELO ID S1807-59322012000700011 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/7206

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