Benefits and risks of success or failure of noninvasive ventilation

Intensive Care Med. 2006 Nov;32(11):1756-65. doi: 10.1007/s00134-006-0324-1. Epub 2006 Sep 21.


Objective: Noninvasive ventilation (NIV) fails more frequently for de novo acute respiratory failure (de novo) than for cardiogenic pulmonary edema (CPE) or acute-on-chronic respiratory failure (AOC). The impact of NIV failure and success was compared between de novo and CPE or AOC after adjustment for disease severity.

Settings: Patients requiring ventilatory support were enrolled in a prospective survey in 70 French ICUs. Of 1076 patients requiring ventilatory support, 524 were eligible, including 299 de novo (NIV use, 30%) and 225 CPE-AOC (NIV use, 55%).

Design and analysis: Independent risk factors associated with mortality and length of stay were identified by logistic regression analysis. The adjusted outcome of NIV success or failure was compared to that with endotracheal intubation without NIV.

Results: NIV success was independently associated with survival in both de novo, adjusted OR 0.05 (95% CI 0.01-0.42), and CPE-AOC OR 0.03 (CI 0.01-0.24). NIV failure was associated with ICU mortality in the de novo group (OR 3.24, CI 1.61-6.53) but not in the CPE-AOC group. Nosocomial pneumonia was less common in patients successful with NIV. NIV failure was associated with a longer ICU stay in CPE-AOC only. The overall use of NIV was independently associated with a better outcome only in CPE-AOC patients (OR 0.33, CI 0.15-0.73).

Conclusion: The effect of NIV differs between de novo and CPE-AOC patients because NIV failure is associated with increased mortality for de novo patients. This finding should raise a note of caution when applying NIV in this indication.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Cross Infection / epidemiology
  • Cross Infection / etiology
  • Hospital Mortality
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Length of Stay
  • Logistic Models
  • Middle Aged
  • Multivariate Analysis
  • Pneumonia / epidemiology
  • Pneumonia / etiology
  • Prospective Studies
  • Pulmonary Edema / mortality
  • Pulmonary Edema / therapy*
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods*
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Risk
  • Treatment Outcome