The Science Journal of the American Association for Respiratory Care
Background: Non-invasive positive pressure ventilation (NIPPV) has become a viable option to avoid intubation in patients with acute respiratory failure. NIPPV is indicated for a variety of medical conditions including COPD, asthma, pulmonary edema and pneumonia. However, the results of prospective, randomized, controlled studies do not yet provide a uniform answer to guide its clinical use for acute respiratory failure. Documentation of predictors of success of NIPPV is needed to assist clinicians in the Emergency Room to select the most appropriate treatment option when respiratory failure appears imminent. The aim of this research project is to identify factors associated with success (survival without intubation) or failure (intubation or death) of NIPPV.
Methods: A retrospective chart review was undertaken of 73 male and 81 female patients (mean age 73.26 years) who received NIPPV in the Emergency Room of an acute care teaching hospital. Information was collected on: admitting diagnosis, vital signs at commencement of NIPPV, blood gases at commencement of NIPPV, medications given, final status, and side effects of NIPPV.
Results: Step-wise logistic regression analysis was used to identify the factors that predicted successful patient outcome when NIPPV was used. These factors were the oxygen saturation level at the time of commencing NIPPV (OR = 1.19, CI (1.07, 1.32), p = .0019) and the bicarbonate level at the time of commencing NIPPV (OR = 0.91, CI (0.85, 0.99), p = .0211). Of the patients studied, 60.3% survived without intubation and 39.7% were intubated or died. Discussion: Review of the data suggests that immediate assessment of saturation and bicarbonate may identify patients for early intubtion thus decreasing morbidity and mortality. Further research is required to determine a standardized aggressive approach to those patients who predictors suggest are not candidates for NIPPV.