Benefits and risks of success or failure of noninvasive ventilation.
OBJECTIVE
Noninvasive ventilation (NIV) fails more frequently for de novo acute respiratory failure (de novo) than for cardiogenic pulmonary edema (CPE) or acute-on-chronic respiratory failure (AOC). The impact of NIV failure and success was compared between de novo and CPE or AOC after adjustment for disease severity.


METHODS
Patients requiring ventilatory support were enrolled in a prospective survey in 70 French ICUs. Of 1076 patients requiring ventilatory support, 524 were eligible, including 299 de novo (NIV use, 30%) and 225 CPE-AOC (NIV use, 55%).


METHODS
Independent risk factors associated with mortality and length of stay were identified by logistic regression analysis. The adjusted outcome of NIV success or failure was compared to that with endotracheal intubation without NIV.


RESULTS
NIV success was independently associated with survival in both de novo, adjusted OR 0.05 (95% CI 0.01-0.42), and CPE-AOC OR 0.03 (CI 0.01-0.24). NIV failure was associated with ICU mortality in the de novo group (OR 3.24, CI 1.61-6.53) but not in the CPE-AOC group. Nosocomial pneumonia was less common in patients successful with NIV. NIV failure was associated with a longer ICU stay in CPE-AOC only. The overall use of NIV was independently associated with a better outcome only in CPE-AOC patients (OR 0.33, CI 0.15-0.73).


CONCLUSIONS
The effect of NIV differs between de novo and CPE-AOC patients because NIV failure is associated with increased mortality for de novo patients. This finding should raise a note of caution when applying NIV in this indication.
Demoule
Alexandre
A
Service de Réanimation Médicale, AP-HP, Hôpital Henri Mondor, 51 av du Mal de Lattre de Tassigny, 94000, Créteil, France.
Girou
Emmanuelle
E
Richard
Jean-Christophe
JC
Taille
Solenne
S
Brochard
Laurent
L
D000368:Aged; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000401:mortality / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012306:Risk; D016896:Treatment Outcome