A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome

Crit Care Med. 2007 Jan;35(1):18-25. doi: 10.1097/01.CCM.0000251821.44259.F3.

Abstract

Objective: In randomized studies of heterogeneous patients with hypoxemic acute respiratory failure, noninvasive positive pressure ventilation (NPPV) was associated with a significant reduction in endotracheal intubation. The role of NPPV in patients with acute respiratory distress syndrome (ARDS) is still unclear. The objective was to investigate the application of NPPV as a first-line intervention in patients with early ARDS, describing what happens in everyday clinical practice in centers having expertise with NPPV.

Design: Prospective, multiple-center cohort study.

Setting: Three European intensive care units having expertise with NPPV.

Patients: Between March 2002 and April 2004, 479 patients with ARDS were admitted to the intensive care units. Three hundred and thirty-two ARDS patients were already intubated, so 147 were eligible for the study.

Interventions: Application of NPPV.

Measurements and main results: NPPV improved gas exchange and avoided intubation in 79 patients (54%). Avoidance of intubation was associated with less ventilator-associated pneumonia (2% vs. 20%; p < .001) and a lower intensive care unit mortality rate (6% vs. 53%; p < .001). Intubation was more likely in patients who were older (p = .02), had a higher Simplified Acute Physiology Score (SAPS) II (p < .001), or needed a higher level of positive end-expiratory pressure (p = .03) and pressure support ventilation (p = .02). Only SAPS II >34 and a Pao2/Fio2 < or =175 after 1 hr of NPPV were independently associated with NPPV failure and need for endotracheal intubation.

Conclusions: In expert centers, NPPV applied as first-line intervention in ARDS avoided intubation in 54% of treated patients. A SAPS II >34 and the inability to improve Pao2/Fio2 after 1 hr of NPPV were predictors of failure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Blood Gas Analysis
  • Critical Care / methods
  • Critical Care / statistics & numerical data*
  • Cross Infection / epidemiology
  • Cross Infection / etiology
  • Decision Trees
  • Female
  • Hospital Mortality
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Italy / epidemiology
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Selection
  • Pneumonia / epidemiology
  • Pneumonia / etiology
  • Positive-Pressure Respiration / adverse effects
  • Positive-Pressure Respiration / methods
  • Positive-Pressure Respiration / statistics & numerical data*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prospective Studies
  • Pulmonary Gas Exchange
  • ROC Curve
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / therapy*
  • Spain / epidemiology
  • Survival Analysis
  • Treatment Outcome