Clinical application of noninvasive ventilation in acute respiratory failure in a general ICU

Abstract

Introduction: Noninvasive ventilation (NIV) is an option in patients with acute respiratory failure [1-3]. However, NIV complications and failure are not yet completely understood [1,2]. Our objective was to evaluate the indications, complications and failure of NIV in an adult general ICU. Methods: From 1 August to 27 October we analyzed prospectively all patients admiTed to a 40-bed clinical-surgical ICU of a tertiary care hospital. From those patients, we included the ones who received NIV (total face mask coupled to a BIPAP Vision® or Synchrony®) and evaluated the indications, causes of failure and the complications of this ventilatory support. Results: During the study period, 465 patients were admiTed to the ICU; 111 patients (23.9%) received NIV. The main indications for NIV were: hypoxemic respiratory failure in 22 patients (19.8%), respiratory infection in 19 (17.1%), acute COPD in 14 (12.6%), as part of a weaning strategy in 16 (14.4%), cardiogenic pulmonary edema in 15 (13.5%), ALI/ARDS in nine (8.1%), palliative care in six (5.4%), neuromuscular disease in one (0.9%) and others in nine patients (8.1%). NIV did not avoid intubation in 31 patients (27.9%). The main reasons for failure were: progressive acute respiratory failure in 23 patients (71.9%) and neurological deterioration in five patients (15.6%). NIV was used after extubation in 16 patients, and in five of them (31%) it was necessary reintubation. The only complication observed was gastric insufflation in six patients (5.4%). Conclusions: NIV is frequently used in a general ICU and the main indication is acute hypoxemic respiratory failure. The NIV failure incidence was significant but similar to the medical literature.