| Noninvasive and invasive ventilation in acute respiratory failure associated with bronchiectasis. | |
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MedLine Citation:
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PMID: 20052456 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure. METHODS: Retrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV. RESULTS: At baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO(2)/FiO(2) ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO(2)/FiO(2) ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease). CONCLUSIONS: The hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients. |
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Authors:
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Jason Phua; Yvonne L E Ang; Kay Choong See; Amartya Mukhopadhyay; Erlinda A Santiago; Eleanor G Dela Pena; Tow Keang Lim |
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Publication Detail:
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Type: Journal Article Date: 2010-01-06 |
Journal Detail:
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Title: Intensive care medicine Volume: 36 ISSN: 1432-1238 ISO Abbreviation: Intensive Care Med Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-12 Completed Date: 2010-06-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 638-47 Citation Subset: IM |
Affiliation:
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Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, 119074, Singapore. phua_jason@yahoo.com.sg |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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APACHE Acute Disease Aged Aged, 80 and over Bronchiectasis / complications*, mortality, therapy* Chi-Square Distribution Female Hospital Mortality Humans Intensive Care Units Length of Stay / statistics & numerical data Logistic Models Male Respiration, Artificial / methods* Respiratory Insufficiency / complications*, mortality, therapy* Retrospective Studies Risk Factors Statistics, Nonparametric Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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