Noninvasive ventilation for acute respiratory failure after lung resection: an observational study.
BACKGROUND
A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome.


METHODS
We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation.


RESULTS
Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P < 0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5; 95% confidence interval, 1.9-68.3; P = 0.007) and no initial response to NIV (odds ratio, 117.6; 95% confidence interval, 10.6-1305.8; P = 0.0001).


CONCLUSIONS
This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection.
Department of Respiratory and Intensive Care Medicine, Hôtel-Dieu Hospital, AP-HP, Université Paris 5, René Descartes, Paris, France.
Aurélie
A
Lefebvre
Christine
C
Lorut
Marco
M
Alifano
Hervé
H
Dermine
Nicolas
N
Roche
Rémy
R
Gauzit
Jean-François
JF
Regnard
Gérard
G
Huchon
Antoine
A
Rabbat
D000208:Acute Disease; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019370:Observation; D011183:Postoperative Complications; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D019616:Thoracic Surgical Procedures