Use and Outcomes of Noninvasive Ventilation for Acute Respiratory Failure in Different Age Groups

Uğurlu, Aylin Özsancak; Sidhom, Samy; Khodabandeh, Ali; Ieong, Michael H.; Mohr, Chester; Lin, Denis; Buchwald, Irwin; Bahhady, Imad; Wengryn, John; Maheshwari, Vinay; Hill, Nicholas S.

doi:10.4187/respcare.03966

Cited by 16 publications

(2 citation statements)

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“…SOFA (37-39), APACHE II (39,40), and lactate (41,42) were also confirmed as independent predictors or related factors of tracheal intubation in previous studies. At the same time, elderly and severe patients being more inclined to choose "non-intubation" may be an important reason why age becomes a protective factor (43)…”

Section: Discussionmentioning

confidence: 99%

Prognostic analysis of high-flow nasal cannula therapy and non-invasive ventilation in mild to moderate hypoxemia patients and construction of a machine learning model for 48-h intubation prediction—a retrospective analysis of the MIMIC database

Fu,

Liu,

Guan

et al. 2024

Front. Med.

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BackgroundThis study aims to investigate the clinical outcome between high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) therapy in mild to moderate hypoxemic patients on the first ICU day and to develop a predictive model of 48-h intubation.MethodsThe study included adult patients from the MIMIC III and IV databases who first initiated HFNC or NIV therapy due to mild to moderate hypoxemia (100 < PaO2/FiO2 ≤ 300). The 48-h and 30-day intubation rates were compared using cross-sectional and survival analysis. Nine machine learning and six ensemble algorithms were deployed to construct the 48-h intubation predictive models, of which the optimal model was determined by its prediction accuracy. The top 10 risk and protective factors were identified using the Shapley interpretation algorithm.ResultA total of 123,042 patients were screened, of which, 673 were from the MIMIC IV database for ventilation therapy comparison (HFNC n = 363, NIV n = 310) and 48-h intubation predictive model construction (training dataset n = 471, internal validation set n = 202) and 408 were from the MIMIC III database for external validation. The NIV group had a lower intubation rate (23.1% vs. 16.1%, p = 0.001), ICU 28-day mortality (18.5% vs. 11.6%, p = 0.014), and in-hospital mortality (19.6% vs. 11.9%, p = 0.007) compared to the HFNC group. Survival analysis showed that the total and 48-h intubation rates were not significantly different. The ensemble AdaBoost decision tree model (internal and external validation set AUROC 0.878, 0.726) had the best predictive accuracy performance. The model Shapley algorithm showed Sequential Organ Failure Assessment (SOFA), acute physiology scores (APSIII), the minimum and maximum lactate value as risk factors for early failure and age, the maximum PaCO2 and PH value, Glasgow Coma Scale (GCS), the minimum PaO2/FiO2 ratio, and PaO2 value as protective factors.ConclusionNIV was associated with lower intubation rate and ICU 28-day and in-hospital mortality. Further survival analysis reinforced that the effect of NIV on the intubation rate might partly be attributed to the other impact factors. The ensemble AdaBoost decision tree model may assist clinicians in making clinical decisions, and early organ function support to improve patients’ SOFA, APSIII, GCS, PaCO2, PaO2, PH, PaO2/FiO2 ratio, and lactate values can reduce the early failure rate and improve patient prognosis.

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Section: Discussionmentioning

confidence: 99%

Prognostic analysis of high-flow nasal cannula therapy and non-invasive ventilation in mild to moderate hypoxemia patients and construction of a machine learning model for 48-h intubation prediction—a retrospective analysis of the MIMIC database

Fu,

Liu,

Guan

et al. 2024

Front. Med.

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show abstract

“…Noninvasive positive-pressure ventilation (NIPPV) has demonstrated efficacy in the management of HF [41]. Elderly patients appear to benefit from this therapy as well, but patients should be carefully selected because contraindications to NIPPV, including altered mental status and an inability to clear secretions and protect the airway, may be present [42,43].…”

Section: Heart Failurementioning

confidence: 99%