title: Noninvasive and invasive ventilation in acute respiratory failure associated with bronchiectasis.
abstract: OBJECTIVE
  To describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure.
  
  
  METHODS
  Retrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV.
  
  
  RESULTS
  At baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO(2)/FiO(2) ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO(2)/FiO(2) ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease).
  
  
  CONCLUSIONS
  The hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients.
authors.affiliation: Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, 119074, Singapore. phua_jason@yahoo.com.sg
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.forename: Yvonne L E
authors.initials: YL
authors.lastname: Ang
authors.forename: Kay Choong
authors.initials: KC
authors.lastname: See
authors.forename: Amartya
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: Erlinda A
authors.initials: EA
authors.lastname: Santiago
authors.forename: Eleanor G
authors.initials: EG
authors.lastname: Dela Pena
authors.forename: Tow Keang
authors.initials: TK
authors.lastname: Lim
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome