Risk factors for noninvasive ventilation failure in patients with acute cardiogenic pulmonary edema: A prospective, observational cohort study

Úbeda-Iglesias, A.; Alonso-Romero, L

doi:10.1016/j.jcrc.2017.04.017

Cited by 1 publication

(1 citation statement)

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“…[12][13][14][15] Finally, understanding the risk factors for NIV failure in patients with AHF is important to guide clinicians' choice of respiratory support modality. 9,[16][17][18][19][20][21][22] To address these knowledge gaps, we conducted a nationwide cohort study of patients with AHF supported with NIV to determine the incidence and predictors of NIV failure and to characterize the magnitude of the association of NIV failure with mortality. We hypothesized that NIV failure would be associated with cardiogenic shock and noncardiac comorbidities and with excess mortality.…”

Section: Introductionmentioning

confidence: 99%

Incidence, Predictors, and Outcomes of Failure of Noninvasive Ventilation in Acute Heart Failure Hospitalization

et al. 2020

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BACKGROUND: Some patients with acute heart failure (AHF) who are treated initially with noninvasive ventilation (NIV) will require endotracheal intubation, which indicates NIV failure. The incidence and prognosis of NIV failure in patients with AHF are not well characterized. METHODS: Using the National In-Patient Sample (NIS), we conducted a retrospective cohort study of subjects hospitalized with AHF between 2008 and 2014 who were treated with NIV within 24 h of hospital admission. We determined predictors of NIV failure and determined the association between NIV failure and in-hospital mortality using Cox proportional hazard models. RESULTS: Of 279,534 subjects hospitalized with AHF and treated with NIV, 4,257 (1.52%) failed NIV and required intubation. Cardiogenic shock (odds ratio 8.79, 95% CI 6.89-11.2) and in-hospital arrest (odds ratio 24.9, 95% CI 18.71-33.14) were associated with NIV failure. In-hospital mortality was 26.5% for NIV failure compared to 5.6% for those without NIV (P < .001). After adjustment for demographics, comorbidities, cardiogenic shock, and in-hospital arrest, NIV failure was associated with nearly a 2-fold risk of inhospital mortality (odds ratio 1.95, 95% CI 1.59-2.40). CONCLUSIONS: Intubation after initial NIV treatment was required in 1.5% of subjects hospitalized with AHF and treated with NIV, and was associated with high in-hospital mortality. These findings can guide future prospective interventional trials and quality improvement ventures.

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