title: Acute respiratory distress syndrome: Predictors of noninvasive ventilation failure and intensive care unit mortality in clinical practice.
abstract: OBJECTIVE
  Noninvasive ventilation (NIV) is used as an initial ventilatory support in acute respiratory distress syndrome (ARDS), but its utility is unclear, and persistence in those who do not improve may delay intubation and lead to adverse outcomes. Hence, it becomes imperative to have a clear understanding of selecting patients who will benefit from this modality.
  
  
  METHODS
  In this prospective observational study, we included all consecutive adults, over a 3-year period, who fulfilled criteria for ARDS by the Berlin definition. Basic demographics, ventilatory support, intensive care unit course, and outcome were recorded.
  
  
  RESULTS
  Of 170 patients, 96 (56.47%) were initially managed with NIV. Noninvasive ventilation failure was seen in 42 (43.75%) of 96, and low baseline PaO2/FIO2, shock, and ARDS severity were associated with NIV failure. Overall intensive care unit mortality was 63 (37.1%) of 170, and high Acute Physiology and Chronic Health Evaluation II score, low PaO2/FIO2, shock, and ARDS severity were associated with increased mortality. Noninvasive ventilation failure and mortality were significantly higher in moderate and severe ARDS.
  
  
  CONCLUSIONS
  Noninvasive ventilation maybe useful in selected patients with mild ARDS but should be used with great caution in moderate and severe ARDS, as failure risk is high. In addition, low PaO2/FIO2 and shock are associated with NIV failure. Acute Physiology and Chronic Health Evaluation II score, shock, low PaO2/FIO2, and ARDS severity are associated with increased mortality.
authors.affiliation: Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Rd, New Delhi, 110076, India. Electronic address: drchawla@hotmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chawla
authors.affiliation: Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Rd, New Delhi, 110076, India. Electronic address: dr.jaimin14@gmail.com.
authors.forename: Jaimin
authors.initials: J
authors.lastname: Mansuriya
authors.affiliation: Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Rd, New Delhi, 110076, India. Electronic address: nikmodi2309@gmail.com.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Modi
authors.affiliation: Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Rd, New Delhi, 110076, India. Electronic address: abhapandey85@gmail.com.
authors.forename: Abha
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Shri Balaji Action Medical Institute, Paschim Vihar, New Delhi, 110063, India. Electronic address: devenjuneja@gmail.com.
authors.forename: Deven
authors.initials: D
authors.lastname: Juneja
authors.affiliation: Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Rd, New Delhi, 110076, India. Electronic address: aakankshachawla@gmail.com.
authors.forename: Aakanksha
authors.initials: A
authors.lastname: Chawla
authors.affiliation: Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Rd, New Delhi, 110076, India. Electronic address: kansalsudha08@gmail.com.
authors.forename: Sudha
authors.initials: S
authors.lastname: Kansal
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000821:virology; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063087:Noninvasive Ventilation / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D012737:Sex Factors; D012772:Shock, Septic / Q000453:epidemiology*; D017211:Treatment Failure
chemical_list: D010100:Oxygen
keywords: Acute respiratory distress syndrome; Berlin definition; ICU; Noninvasive ventilation