Abstract
The efficacy of noninvasive positive pressure ventilation (NPPV) for acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema has already been proven. However, the efficacy of NPPV for acute lung injury and acute respiratory distress syndrome (ALI/ARDS) has not yet been completely proven. In our ICU, we consider using NPPV for ALI/ARDS cases, depending on the severity, but intubation is still required in many severe cases. It is important to predict failure in cases treated with NPPV. In this study, we retrospectively compared the clinical data and outcomes to determine the predictors of NPPV failure. Data of 57 patients who were treated with NPPV in our ICU from 2008 to 2010 were reviewed. These patients were divided into 2 groups: the success group, which included 38 patients who had achieved remission with NPPV, and the failure group, which included 19 patients who had died or required intubation. The success rate of NPPV was 67%. The APACHE II score of the failure group was significantly higher than that of the success group (17.7 ± 7.6 vs. 12.9 ± 4.3, p = 0.003). The respiratory rate (RR) of the failure group was significantly higher (35.9 ± 8.6 vs. 27.1 ± 6.3, p = 0.002) before the use of NPPV. In addition, RR of both the groups showed the same tendency after the use of NPPV. Multivariate analysis identified RR (odds ration [OR] 0.82, 95% confidence interval [CI] 0.72-0.94) and APACHE II score (OR 0.82, 95% CI 0.67-0.99) as factors associated with NPPV success. When the success rate of NPPV was assumed to be >60%, patients with an RR >30 or an APACHE II score >17 had difficulty achieving remission. Therefore, careful observation is needed and intubation should be considered for these patients.
