title: Factors associated with noninvasive ventilation failure in postoperative acute respiratory insufficiency: an observational study.
abstract: OBJECTIVE
  Few data are available on the efficacy of noninvasive ventilation (NIV) in postoperative patients with acute respiratory failure (ARF).
  
  
  METHODS
  Seventy-two patients coming from the surgical wards with postoperative ARF were retrospectively evaluated. The major characteristics of patients who were intubated were compared with the characteristics of those who were not after a trial of NIV. Predictive factors for failure of NIV were analysed.
  
  
  RESULTS
  Out of 72 patients with ARF after surgery who were treated with NIV, 42 avoided intubation (58%). On a univariate analysis, a decrease in the paO2/FiO2 ratio after 1 h of NIV (223 +/- 84 to 160 +/- 68 mmHg, P < 0.05) was associated with NIV failure and need for tracheal intubation because of nosocomial pneumonia and an increased simplified acute physiology score (SAPS) 2. In a multivariate analysis, nosocomial pneumonia [odds ratio (OR) 4.189; 95% confidence interval (CI) 1.383-12.687] and SAPS 2 higher than 35 (OR 4.969; 95% CI 1.627-15.172) were independent predictive factors of NIV failure. NIV success was associated with a reduced ICU stay (16.8 vs. 26.1 days, P < 0.001).
  
  
  CONCLUSIONS
  NIV could be considered in postoperative patients who presented with ARF. Nosocomial pneumonia is predictive of NIV failure.
authors.affiliation: Anaesthesiology and Surgical Critical Care Department, Lyon University Croix Rousse Hospital, Lyon, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Wallet
authors.forename: Mathieu
authors.initials: M
authors.lastname: Schoeffler
authors.forename: Marie
authors.initials: M
authors.lastname: Reynaud
authors.forename: Serge
authors.initials: S
authors.lastname: Duperret
authors.forename: Sintayou
authors.initials: S
authors.lastname: Workineh
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Viale
mesh_terms: D000208:Acute Disease; D003428:Cross Infection / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications; D011175:Positive-Pressure Respiration / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000628:therapy*; D011237:Predictive Value of Tests; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure