Risk factors associated with failure of noninvasive positive pressure ventilation in acute respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease_West China Medical Journal

Authors：

YE Jingfan , LIU Jiali , DONG Fei ,  TANG Xiaokui

Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

TANG Xiaokui, Email: txk1200@126.com

Keywords：

Chronic obstructive pulmonary disease; Acute exacerbation; Acute respiratory failure; Endotracheal intubation; Noninvasive positive pressure ventilation

DOI：

10.7507/1002-0179.201612093

Video：

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Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO₂), PaO₂/fraction of inspired oxygen (FiO₂) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO₂ after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO₂/FiO₂ after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.

Citation： YE Jingfan, LIU Jiali, DONG Fei, TANG Xiaokui. Risk factors associated with failure of noninvasive positive pressure ventilation in acute respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease. West China Medical Journal, 2017, 32(11): 1702-1707. doi: 10.7507/1002-0179.201612093 Copy

1.	Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333(13): 817-822.
2.	Lindenauer PK, Stefan MS, Shieh MS, et al. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med, 2014, 174(12): 1982-1993.
3.	Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and meta analysis. Chest, 2008, 133(3): 756-766.
4.	孙同文, 万有栋, 阚全程, 等. 无创通气对急性心原性肺水肿患者院内病死率影响的荟萃分析. 中华心血管病杂志, 2014, 42(2): 161-168.
5.	Carson KV, Usmani ZA, Smith BJ. Noninvasive ventilation in acute severe asthma: current evidence and future perspectives. Curr Opin Pulm Med, 2014, 20(1): 118-123.
6.	Brochard L, Lefebvre JC, Cordioli RL, et al. Noninvasive ventilation for patients with hypoxemic acute respiratory failure. Semin Respir Crit Care Med, 2014, 35(4): 492-500.
7.	Namendys-Silva SA, Hernández-Garay M, Herrera-Gómez A. Noninvasive ventilation in immunosuppressed patients. Am J Hosp Palliat Care, 2010, 27(2): 134-138.
8.	Jaber S, De Jong A, Castagnoli A, et al. Non-invasive ventilation after surgery. Ann Fr Anesth Reanim, 2014, 33(7/8): 487-491.
9.	Elliott MW. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: a new Gold standard?. Intensive Care Med, 2002, 28(12): 1691-1694.
10.	Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ, 2003, 326(7382): 185.
11.	Squadrone E, Frigerio P, Fogliati C, et al. Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance. Intensive Care Med, 2004, 30(7): 1303-1310.
12.	Shi JX, Xu J, Sun WK, et al. Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis. Chin Med J (Engl), 2013, 126(1): 140-146.
13.	Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J, 2005, 25(2): 348-355.
14.	Nicolini A, Ferrera L, Santo M, et al. Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure. Pol Arch Med Wewn, 2014, 124(10): 525-531.
15.	Kida Y, Minakata Y, Yamada Y, et al. Efficacy of noninvasive positive pressure ventilation in elderly patients with acute hypercapnic respiratory failure. Respiration, 2012, 83(5): 377-382.
16.	Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification-system. Crit Care Med, 1985, 13(10): 818-829.
17.	Glerant JC, Rose D, Oltean V, et al. Noninvasive ventilation using a mouthpiece in patients with chronic obstructive pulmonary disease and acute respiratory failure. Respiration, 2007, 74(6): 632-639.
18.	Mccurdy BR. Noninvasive positive pressure ventilation for acute respiratory failure patients with chronic obstructive pulmonary disease (COPD): an evidence-based analysis. Ont Health Technol Assess Ser, 2012, 12(8): 1-102.
19.	Nava S, Ceriana P. Cause of failure of noninvasive mechanical ventilation. Respir Care, 2004, 49(3): 295-303.
20.	Ozyilmaz E, Ugurlu Ao, Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med, 2014, 14: 19.
21.	Martín-González F, González-Robledo J, Sánchez-Hernández F, et al. Effectiveness and predictors of failure of noninvasive mechanical ventilation in acute respiratory failure. Med Intensiva, 2016, 40(1): 9-17.
22.	Stefan MS, Nathanson BH, Higgins TL, et al. Comparative effectiveness of noninvasive and invasive ventilation in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease. Crit Care Med, 2015, 43(7): 1386-1394.
23.	Merlani PG, Pasquina P, Granier JM, et al. Factors associated with failure of noninvasive positive pressure ventilation in the emergency department. Acad Emerg Med, 2005, 12(12): 1206-1215.
24.	Scala R, Naldi M, Archinucci I, et al. Noninvasive positive pressure ventilation in patients with acute exacerbations of COPD and varying levels of consciousness. Chest, 2005, 128(3): 1657-1666.
25.	中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者机械通气指南(2007). 中华急诊医学杂志, 2007, 16(4): 350-357.

1. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333(13): 817-822.
2. Lindenauer PK, Stefan MS, Shieh MS, et al. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med, 2014, 174(12): 1982-1993.
3. Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and meta analysis. Chest, 2008, 133(3): 756-766.
4. 孙同文, 万有栋, 阚全程, 等. 无创通气对急性心原性肺水肿患者院内病死率影响的荟萃分析. 中华心血管病杂志, 2014, 42(2): 161-168.
5. Carson KV, Usmani ZA, Smith BJ. Noninvasive ventilation in acute severe asthma: current evidence and future perspectives. Curr Opin Pulm Med, 2014, 20(1): 118-123.
6. Brochard L, Lefebvre JC, Cordioli RL, et al. Noninvasive ventilation for patients with hypoxemic acute respiratory failure. Semin Respir Crit Care Med, 2014, 35(4): 492-500.
7. Namendys-Silva SA, Hernández-Garay M, Herrera-Gómez A. Noninvasive ventilation in immunosuppressed patients. Am J Hosp Palliat Care, 2010, 27(2): 134-138.
8. Jaber S, De Jong A, Castagnoli A, et al. Non-invasive ventilation after surgery. Ann Fr Anesth Reanim, 2014, 33(7/8): 487-491.
9. Elliott MW. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: a new Gold standard?. Intensive Care Med, 2002, 28(12): 1691-1694.
10. Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ, 2003, 326(7382): 185.
11. Squadrone E, Frigerio P, Fogliati C, et al. Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance. Intensive Care Med, 2004, 30(7): 1303-1310.
12. Shi JX, Xu J, Sun WK, et al. Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis. Chin Med J (Engl), 2013, 126(1): 140-146.
13. Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J, 2005, 25(2): 348-355.
14. Nicolini A, Ferrera L, Santo M, et al. Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure. Pol Arch Med Wewn, 2014, 124(10): 525-531.
15. Kida Y, Minakata Y, Yamada Y, et al. Efficacy of noninvasive positive pressure ventilation in elderly patients with acute hypercapnic respiratory failure. Respiration, 2012, 83(5): 377-382.
16. Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification-system. Crit Care Med, 1985, 13(10): 818-829.
17. Glerant JC, Rose D, Oltean V, et al. Noninvasive ventilation using a mouthpiece in patients with chronic obstructive pulmonary disease and acute respiratory failure. Respiration, 2007, 74(6): 632-639.
18. Mccurdy BR. Noninvasive positive pressure ventilation for acute respiratory failure patients with chronic obstructive pulmonary disease (COPD): an evidence-based analysis. Ont Health Technol Assess Ser, 2012, 12(8): 1-102.
19. Nava S, Ceriana P. Cause of failure of noninvasive mechanical ventilation. Respir Care, 2004, 49(3): 295-303.
20. Ozyilmaz E, Ugurlu Ao, Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med, 2014, 14: 19.
21. Martín-González F, González-Robledo J, Sánchez-Hernández F, et al. Effectiveness and predictors of failure of noninvasive mechanical ventilation in acute respiratory failure. Med Intensiva, 2016, 40(1): 9-17.
22. Stefan MS, Nathanson BH, Higgins TL, et al. Comparative effectiveness of noninvasive and invasive ventilation in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease. Crit Care Med, 2015, 43(7): 1386-1394.
23. Merlani PG, Pasquina P, Granier JM, et al. Factors associated with failure of noninvasive positive pressure ventilation in the emergency department. Acad Emerg Med, 2005, 12(12): 1206-1215.
24. Scala R, Naldi M, Archinucci I, et al. Noninvasive positive pressure ventilation in patients with acute exacerbations of COPD and varying levels of consciousness. Chest, 2005, 128(3): 1657-1666.
25. 中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者机械通气指南(2007). 中华急诊医学杂志, 2007, 16(4): 350-357.

West China Medical Journal

Risk factors associated with failure of noninvasive positive pressure ventilation in acute respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease

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