Noinvasive Ventilation in Relapse of Acute Respiratory Failure outside ICU

Abstract

The transfer of patients to the ICU from the general ward could be a frequent issue of major concern in many hospitals around the world. We accessed the effectiveness of NIMV protocol outside ICU in subgroup of patients with relapse of acute respiratory failure and we also determined the factors associated with ICU transfer. This work is a prospective observational study. A total of 525 patients were treated of acute respiratory failure during this period of three years study. Of this, 353 (67.2%) were managed with standard therapy and 46 (8.7%) were presented with relapse and required NIMV outside ICU. The most frequent diagnoses were: COPD 22 (47.8%), CAP 13 (28.3%), CHF 5 (10.9%), asthma 4 (8.7), and diffuse interstitial pulmonary disease 2 (4.3%). Levels of IPAP were 13.5 ± 2.1 and EPAP 6.1 ± 0.8. Respiratory acidosis, the most recent finding, was (82.6%); transfer to the ICU, 5 (10.9%), and need for endotracheal intubation, 3 (6.5%). 2 (4.3%) patients in the study died and 44 (95.7%) patients were alive. The variables associated with transfer to the ICU were: IPAP level (p = 0.005), EPAP level (p = 0.03), antibiotic regimen changes (p = 0.01), and elevated HR (p = 0.04) and acidbase disorders (p = 0, 10). Cumulative survival at 13 months was 86% and in 36 months it was 73% by the Kaplan-Meier method. We identified a sub-group of patients who can benefit from the early application of NIMV protocol outside ICU after the relapse of acute respiratory failure. However, a multicentre study that involves a greater number of patients with these characteristic could be required