Noninvasive and invasive ventilation in acute respiratory failure associated with bronchiectasis

Intensive Care Med. 2010 Apr;36(4):638-47. doi: 10.1007/s00134-009-1743-6. Epub 2010 Jan 6.


Purpose: To describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure.

Methods: Retrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV.

Results: At baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO(2)/FiO(2) ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO(2)/FiO(2) ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease).

Conclusions: The hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients.

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Bronchiectasis / complications*
  • Bronchiectasis / mortality
  • Bronchiectasis / therapy*
  • Chi-Square Distribution
  • Female
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Respiration, Artificial / methods*
  • Respiratory Insufficiency / complications*
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Retrospective Studies
  • Risk Factors
  • Statistics, Nonparametric
  • Treatment Outcome