Variables predictive of outcome in patients with acute hypercapneic respiratory failure treated with noninvasive ventilation.
OBJECTIVE
To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors.


METHODS
This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of < 0.05 was considered statistically significant. Software used was SPSS 14.


RESULTS
Total numbers of patients included were 119; 52.9% were males. Mean age was 63.4 +/- 11.9 years. Overall Survival to discharge rate was 76.5%, intubation rate was 12.6% and mean length of stay was 11.4 +/- 10.9 days. Statistically significant improvements were observed in the pH and PaCO2 at 24 hours and 48 hours compared to baseline (7.28 v/s 7.37, p < 0.001; 74.2 v/s 65, p < 0.001). On multivariate regression analysis, sepsis at admission predicted mortality (adjusted Odds ratio 26.4; 95% CI 2.3, 304, p < 0.009). A serum HCO3 > 35 Meq/L (adjusted Odds ratio 0.9; 95% CI 0.83, 0.98, p < 0.015) identified those less at risk for intubation.


CONCLUSIONS
NIV was found to be both safe and effective in the management of acute hypercapneic respiratory failure. Sepsis and serum HCO3 at admission identified patients having poor outcomes.
Salahuddin
Nawal
N
Section of Pulmonary & Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan.
Irfan
Muhammad
M
Khan
Shereen
S
Naeem
Muhammad
M
Haque
Ahmad Suleman
AS
Husain
Shahid Javed
SJ
Rao
Nisar Ahmed
NA
Zubairi
Ali Bin Sarwar
AB
Khan
Javaid Ahmed
JA
D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors