Document Detail


Noninvasive and invasive ventilation in acute respiratory failure associated with bronchiectasis.
MedLine Citation:
PMID:  20052456     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article     Date:  2010-01-06
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-12     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  638-47     Citation Subset:  IM    
Affiliation:
Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, 119074, Singapore. phua_jason@yahoo.com.sg
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MeSH Terms
Descriptor/Qualifier:
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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