Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital.
OBJECTIVE
To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis.


METHODS
A prospective cohort study.


RESULTS
Medical disorders (59%) and elective surgery (21%) were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55%) and a decreased level of consciousness (20%). The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5) versus four (3-7) days]; they had lower levels of pH, HCO3 and base excess, and the FiO2 level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26) days vs. 8 (5-14) days], as well as a higher mortality rate (9 vs. 51%). There was an association between failure and mortality, which had an odds ratio (95% CI) of 10.6 (5.93 -19.07). The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II ≥ 34, an inspiratory positive airway pressure level ≥ 15 cmH2O and pH<7.40.


CONCLUSIONS
The indications for noninvasive positive-pressure ventilation were quite varied. The failure group had a longer intensive care unit stay and higher mortality. Simplified Acute Physiology Score II ≥ 34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.
Federal University of São Paulo, Department of Human Movement Sciences, Santos/SP, Brazil. liria_yamauchi@yahoo.com.br
Liria Yuri
LY
Yamauchi
Teresa Cristina Francischetto
TC
Travaglia
Sidnei Ricardo Nobre
SR
Bernardes
Maise C
MC
Figueiroa
Clarice
C
Tanaka
Carolina
C
Fu
D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome