Document Detail


Noninvasive versus conventional mechanical ventilation. An epidemiologic survey.
MedLine Citation:
PMID:  11282759     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A prospective survey was performed over a period of 3 wk among 42 intensive care units to assess the incidence of use and effectiveness of noninvasive mechanical ventilation (NIV) in clinical practice. All patients requiring ventilatory support for acute respiratory failure (ARF), either with endotracheal intubation (ETI) or NIV, were included. Ventilatory support was required in 689 patients, 581 with ETI and 108 (16%) with NIV (35% of patients not intubated on admission). Reasons for mechanical ventilation were coma (30%), cardiogenic pulmonary edema (7%), and hypoxemic (48%) and hypercapnic ARF (15%). NIV was never used for patients in coma (who were excluded from further analysis), but was used in 14% of patients with hypoxemic ARF, in 27% of those with pulmonary edema, and in 50% of those with hypercapnic ARF. NIV was followed by ETI in 40% of cases. The incidence of both nosocomial pneumonia (10% versus 19%, p = 0.03), and mortality (22% versus 41%, p < 0.001) was lower in NIV patients than in those with ETI. After adjusting for differences at baseline, Simplified Acute Physiology Score (SAPS) II (odds ratio [OR] = 1.05 per point; confidence interval [CI]: 1.04 to 1.06), McCabe/Jackson score (OR = 2.18; CI: 1.57 to 3.03), and hypoxemic ARF (OR = 2.30; CI: 1.33 to 4.01) were identified as risk factors explaining mortality; success of NIV was associated with a lower risk of pneumonia (OR = 0.06; CI: 0.01 to 0.45) and of death (OR = 0.16; CI: 0.05 to 0.54). In NIV patients, SAPS II and a poor clinical tolerance predicted secondary ETI. Failure of NIV was associated with a longer length of stay. In conclusion, NIV can be successful in selected patients, and is associated with a lower risk of pneumonia and death than is ETI.
Authors:
A Carlucci; J C Richard; M Wysocki; E Lepage; L Brochard;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  163     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-04-03     Completed Date:  2001-05-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  874-80     Citation Subset:  AIM; IM    
Affiliation:
Paris XII Université, Department of Biostatistics, Medical Intensive Care Unit, Institut National de la Recherche et de la Santé Medicale U 492, Henri Mondor Hospital, Créteil, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Confidence Intervals
Data Collection
Female
France
Humans
Intensive Care Units / statistics & numerical data
Intubation, Intratracheal / methods*,  statistics & numerical data
Male
Middle Aged
Odds Ratio
Probability
Prognosis
Prospective Studies
Respiration, Artificial / methods*,  statistics & numerical data
Respiratory Insufficiency / diagnosis,  mortality,  therapy*
Sensitivity and Specificity
Severity of Illness Index
Statistics, Nonparametric
Survival Rate
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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