title: Risk factors for noninvasive ventilation failure in patients with acute cardiogenic pulmonary edema: A prospective, observational cohort study.
abstract: We identified risk factors for noninvasive ventilation (NIV) failure in patients with acute cardiogenic pulmonary edema (ACPE).
  
  
  
  We conducted an observational cohort study over a 3-year period in a 28-bed emergency intensive care unit (EICU) and prospectively included all consecutive patients in whom NIV was attempted as initial ventilatory support for ACPE. The primary outcome variables were NIV failure rate and risk factors for NIV failure.
  
  
  
  Among the 118 patients in the study, NIV failed for 44 (37.3%) patients. Risk factors for NIV failure were Killip class IV (odds ratio [OR], 28.56; 95% confidence interval [CI], 2.17-375.73; p=0.011), left ventricular ejection fraction (LVEF) <30% (OR, 9.54; 95% CI, 1.01-90.55; p=0.050) and B-type natriuretic peptide (BNP) ≥3350pg/mL (OR, 39.63; 95% CI, 3.92-400.79; p=0.002) at baseline, and fluid balance ≥400mL within 24h after ACPE (OR, 13.19; 95% CI, 1.18-147.70; p=0.036).
  
  
  
  NIV failure occurred in 37.3% of ACPE patients in a real-world EICU. When patients had Killip class IV, a lower LVEF, a higher BNP, and a more positive fluid balance within 24h after ACPE, the risk of failure was higher. TRIAL REGISTRATION CLINICALTRIALS.
  
  
  
  NCT02653365.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing 100043, China. Electronic address: xmjg2002@163.com.
authors.forename: Zujin
authors.initials: Z
authors.lastname: Luo
authors.affiliation: Emergency Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China. Electronic address: hanfusheng2004@aliyun.com.
authors.forename: Fusheng
authors.initials: F
authors.lastname: Han
authors.affiliation: National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nan Wei Road, Xicheng District, Beijing 100050, China. Electronic address: alexleeliyichong@163.com.
authors.forename: Yichong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China. Electronic address: yonghang2004@sina.com.
authors.forename: Hangyong
authors.initials: H
authors.lastname: He
authors.affiliation: Emergency Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China. Electronic address: 13811657755@yeah.net.
authors.forename: Gen
authors.initials: G
authors.lastname: Yang
authors.affiliation: Emergency Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China. Electronic address: myhicu@163.com.
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Mi
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing 100043, China. Electronic address: ma.yingmin@163.com.
authors.forename: Yingmin
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing 100043, China. Electronic address: caozhixinicu@126.com.
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Cao
mesh_terms: D000208:Acute Disease; D000368:Aged; D003625:Data Collection; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects*; D016017:Odds Ratio; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000150:complications* / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute cardiogenic pulmonary edema; Endotracheal intubation; Noninvasive ventilation; Risk factor