Noninvasive ventilation failure in patients with hypoxemic respiratory failure: the role of sepsis and septic shock

Duan, Jun; Chen, Lijuan; Liang, Guopeng; Shu, Weiwei; Li, Liucun; Wang, Ke; Wang, Shengyu; Liu, Xiaoyi; He, Chunfeng; He, Dehua; Chen, Qimin; Wei, Bilin; Chen, Baixu; Shu, Yuzhen; Tian, Yao; Fan, Liping; Han, Xiaoli; Zhang, Rui; Yang, Xiangmei; Peng, Yan; Wan, Dong; Chen, Xiaoying; Ye, Lin; Tian, Shijing; Huang, Qiong; Jiang, Lei; Bai, Linfu; Zhou, Lintong

doi:10.1177/1753466619888124

Cited by 15 publications

(18 citation statements)

References 30 publications

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“…Among all the patients who used NIV as first-line therapy, the intubation rate was 92% in patients with Middle East respiratory syndrome, 30% in patients with severe acute respiratory syndrome, and 59% in patients with influenza pneumonia [ [23] , [24] , [25] ]. In hypoxemic patients whose respiratory failure caused by other reasons, the intubation rate was 36% [ 26 ]. However, in our study, the intubation rate was only 15% in COVID-19 patients who used NIV as a first-line intervention.…”

Section: Discussionmentioning

confidence: 99%

Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

Duan

Chen

Liu

et al. 2021

The American Journal of Emergency Medicine

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Background The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) in patients with COVID-19 is debated. Methods This study was performed in four hospitals of China from January to March 2020. We retrospectively enrolled 23 and 13 COVID-19 patients who used HFNC and NIV as first-line therapy, respectively. Results Among the 23 patients who used HFNC as first-line therapy, 10 experienced HFNC failure and used NIV as rescue therapy. Among the 13 patients who used NIV as first-line therapy, one (8%) used HFNC as rescue therapy due to NIV intolerance. The duration of HFNC + NIV (median 7.1, IQR: 3.5–12.2 vs. 7.3, IQR: 5.3–10.0 days), intubation rate (17% vs. 15%) and mortality (4% vs. 8%) did not differ between patients who used HFNC and NIV as first-line therapy. In total cohorts, 6 (17%) patients received intubation. Time from initiation of HFNC or NIV to intubation was 8.4 days (IQR: 4.4–18.5). And the time from initiation of HFNC or NIV to termination in patients without intubation was 7.1 days (IQR: 3.9–10.3). Among all the patients, C-reactive protein was independently associated with intubation (OR = 1.04, 95% CI: 1.01–1.07). In addition, no medical staff got nosocomial infection who participated in HFNC and NIV management. Conclusions In critically ill patients with COVID-19 who used HFNC and NIV as first-line therapy, the duration of HFNC + NIV, intubation rate and mortality did not differ between two groups. And no medical staff got nosocomial infection during this study.

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Section: Discussionmentioning

confidence: 99%

Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

Duan

Chen

Liu

et al. 2021

The American Journal of Emergency Medicine

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“…Sepsis and septic shock increases the risk of failure of NIV by 1.5 to 2.5 times, respectively, with no difference between pulmonary and non-pulmonary source. 22 Sepsis was present in seven cases in our series. Six cases had pneumonia and one had cellulitis leg, but none of them were in shock.…”

Section: Discussionmentioning

confidence: 51%

Voluntary Prone Position for Acute Hypoxemic Respiratory Failure in Unintubated Patients

Rao

Udhayachandar

Rao

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Severe hypoxemic respiratory failure is frequently managed with invasive mechanical ventilation with or without prone position (PP). We describe 13 cases of nonhypercapnic acute hypoxemic respiratory failure (AHRF) of varied etiology, who were treated successfully in PP without the need for intubation. Noninvasive ventilation (NIV), high-flow oxygen via nasal cannula, supplementary oxygen with venturi face mask, or nasal cannula were used variedly in these patients. Mechanical ventilatory support is offered to patients with AHRF when other methods, such as NIV and oxygen via high-flow nasal cannula, fail. Invasive mechanical ventilation is fraught with complications which could be immediate, ranging from worsening of hypoxemia, worsening hemodynamics, loss of airway, and even death. Late complications could be ventilator-associated pneumonia, biotrauma, tracheal stenosis, etc. Prone position is known to improve oxygenation and outcome in adult respiratory distress syndrome. We postulated that positioning an unintubated patient with AHRF in PP will improve oxygenation and avoid the need for invasive mechanical ventilation and thereby its complications. Here, we describe a series of 13 patients with hypoxemic respiratory of varied etiology, who were successfully treated in the PP without endotracheal intubation. Two patients (15.4%) had mild, nine (69.2%) had moderate, and two (15.4%) had severe hypoxemia. Oxygenation as assessed by PaO 2 /FiO 2 ratio in supine position was 154 ± 52, which improved to 328 ± 65 after PP. Alveolar to arterial (A-a) O 2 gradient improved from a median of 170.5 mm Hg interquartile range (IQR) (127.8, 309.7) in supine position to 49.1 mm Hg IQR (45.0, 56.6) after PP. This improvement in oxygenation took a median of 46 hours, IQR (24, 109). Thus, voluntary PP maneuver improved oxygenation and avoided endotracheal intubation in a select group of patients with hypoxemic respiratory failure. This maneuver may be relevant in the ongoing novel coronavirus disease pandemic by potentially reducing endotracheal intubation and the need for ventilator and therefore better utilization of critical care services. How to cite this article Rao SV, Udhayachandar R, Rao VB, Raju NA, Nesaraj JJJ, Kandasamy S, et al. Voluntary Prone Position for Acute Hypoxemic Respiratory Failure in Unintubated Patients. Indian J Crit Care Med 2020;24(7):557–562.

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“…The initiation of NIV was based on a protocol we published previously: respiratory rate > 25 breaths/min, or clinical presentation of respiratory distress at rest (such as active contraction of the accessory inspiratory muscles or paradoxical abdominal motion), and PaO 2 < 60 mmHg at room air or PaO 2 /FiO 2 < 300 mmHg with supplemental oxygen [19]. However, the use of NIV was at the attending physician's discretion.…”

Section: Methodsmentioning

confidence: 99%

“…Liberation from NIV was considered if the respiratory failure was reversed. The reversal of respiratory failure was de ned according to previously published criteria: PaO 2 /FiO 2 > 300 mmHg, respiratory rate < 25 breaths/min, and no clinical symptoms indicating respiratory distress [19]. However, if respiratory failure deteriorated progressively and required intubation, intubation for invasive mechanical ventilation was performed.…”

Section: Methodsmentioning

confidence: 99%

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Impact of ARDS Etiology on the Failure of Noninvasive Ventilation and 28-Day Mortality: A Multicenter Prospective Observational Study

Shu

Guo

Yang

et al. 2021

Preprint

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Background: The failure rate of noninvasive ventilation (NIV) remains high in patients with acute respiratory distress syndrome (ARDS). The etiology of ARDS may play an important role in NIV failure.Methods: A multicenter prospective observational study was performed in 17 ICUs in China from September 2017 to December 2019. ARDS patients who used NIV as a first-line therapy were enrolled. The etiology of ARDS was recorded at study entry. Results: A total of 306 patients were enrolled. Of the patients, 146 were classified as having pulmonary ARDS (ARDSp) and 160 were classified as having extrapulmonary ARDS (ARDSexp). NIV improved PaO2/FiO2 from initiation to 24 h of NIV in both groups. However, it improved more slowly in patients with ARDSp than in those with ARDSexp (interaction effect: p < 0.01). ARDSp patients experienced more NIV failure (55% vs. 28%; p < 0.01) and higher 28-day mortality (47% vs. 14%; p < 0.01). The multivariate Cox regression also showed that ARDSp was independently associated with NIV failure (hazard ratio [HR] = 2.81, 95% confidence interval [CI]: 1.89-4.18) and 28-day mortality (HR = 7.49, 95% CI: 4.32-13.01). After propensity matching, 62 patients remained in each group. The baseline data were comparable between the two groups. ARDSp was still independently associated with NIV failure and 28-day mortality (HR = 2.62, 95%CI: 1.49-4.61; and 5.70, 2.59-12.55, respectively). Sensitivity analysis also confirmed these results. Conclusions: Among ARDS patients who used NIV as a first-line therapy, ARDSp was associated with slower improvement in oxygenation, more NIV failure, and higher 28-day mortality than ARDSexp.

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Noninvasive ventilation failure in patients with hypoxemic respiratory failure: the role of sepsis and septic shock

Cited by 15 publications

References 30 publications

Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

Voluntary Prone Position for Acute Hypoxemic Respiratory Failure in Unintubated Patients

Impact of ARDS Etiology on the Failure of Noninvasive Ventilation and 28-Day Mortality: A Multicenter Prospective Observational Study

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