Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection.

Despite wide use of noninvasive ventilation (NIV) in several clinical settings, the beneficial effects of NIV in patients with hypoxemic acute respiratory failure (ARF) due to influenza infection remain controversial. The aim of this study was to identify the profile of patients with risk factors for NIV failure using chi-square automatic interaction detection (CHAID) analysis and to determine whether NIV failure is associated with ICU mortality. This work was a secondary analysis from prospective and observational multi-center analysis in critically ill subjects admitted to the ICU with ARF due to influenza infection requiring mechanical ventilation. Three groups of subjects were compared: (1) subjects who received NIV immediately after ICU admission for ARF and then failed (NIV failure group); (2) subjects who received NIV immediately after ICU admission for ARF and then succeeded (NIV success group); and (3) subjects who received invasive mechanical ventilation immediately after ICU admission for ARF (invasive mechanical ventilation group). Profiles of subjects with risk factors for NIV failure were obtained using CHAID analysis. Of 1,898 subjects, 806 underwent NIV, and 56.8% of them failed. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, infiltrates in chest radiograph, and ICU mortality (38.4% vs 6.3%) were higher (P < .001) in the NIV failure than in the NIV success group. SOFA score was the variable most associated with NIV failure, and 2 cutoffs were determined. Subjects with SOFA ≥ 5 had a higher risk of NIV failure (odds ratio = 3.3, 95% CI 2.4-4.5). ICU mortality was higher in subjects with NIV failure (38.4%) compared with invasive mechanical ventilation subjects (31.3%, P = .018), and NIV failure was associated with increased ICU mortality (odds ratio = 11.4, 95% CI 6.5-20.1). An automatic and non-subjective algorithm based on CHAID decision-tree analysis can help to define the profile of patients with different risks of NIV failure, which might be a promising tool to assist in clinical decision making to avoid the possible complications associated with NIV failure.

Rodríguez A ，Ferri C ，Martin-Loeches I ，Díaz E ，Masclans JR ，Gordo F ，Sole-Violán J ，Bodí M ，Avilés-Jurado FX ，Trefler S ，Magret M ，Moreno G ，Reyes LF ，Marin-Corral J ，Yebenes JC ，Esteban A ，Anzueto A ，Aliberti S ，Restrepo MI ，Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group ，2009-2015 H1N1 SEMICYUC Working Group investigators ... -  《-》

Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study.

Corrêa TD ，Sanches PR ，de Morais LC ，Scarin FC ，Silva E ，Barbas CS ... -  《BMC Pulmonary Medicine》

A survey of noninvasive ventilation practices in a respiratory ICU of North India.

Sharma S ，Agarwal R ，Aggarwal AN ，Gupta D ，Jindal SK ... -  《-》

Risk factors for non-invasive ventilation failure in influenza infection with acute respiratory failure in emergency department.

Non-invasive ventilation (NIV) has been widely used in hypoxemic acute respiratory failure (ARF) due to influenza pneumonia in the emergency department (ED). However, NIV used in influenza-associated acute respiratory failure had a variable rate of failure. Previous studies have reported that prolonged use of NIV was associated with increased mortality. Our study aimed to identify risk factors for NIV failure in influenza infection with acute respiratory failure in ED. We performed a retrospective cohort observational study. Enrolled patients were older than 18 years who used NIV due to influenza infection with ARF between 1 January 2017 to 31 December 2018 in Ramathibodi Emergency Department. Patients characteristics, comorbidity, clinical, laboratory outcome, chest imaging, initial NIV setting, and parameters were collected in ED setting. Sequential organ failure assessment (SOFA) score and PaO2/FiO2 (PF) ratio were calculated from the first arterial blood gas in ED. We followed the outcome success or failure of the NIV used. A total of 162 patients were enrolled and 72 (44%) suffered NIV failure in influenza infection with ARF. We used univariate and multivariate logistic analyses to assess risk factors for NIV failure. The ability of risk factor to predict NIV failure was analyzed using the area under the receiver operating characteristic (AUROC). Risk factors of NIV failure included SOFA score (P = 0.001), PF ratio (P = 0.001) and quadrant infiltrations in chest x-rays (CXR) (P = 0.001). SOFA score, PF ratio, and number quadrant infiltrations in chest radiography have good ability to predict NIV failure, AUROC 0.894 (95%CI 0.839-0.948), 0.828 (95%CI 0.764-0.892), and 0.792 (95%CI 0.721-0.863), respectively and no significant difference in the ability to predict NIV failure among three parameters. The use of PF ratio plus number quadrant infiltrations in chest radiography demonstrated a higher predictive ability for NIV failure in influenza infection with ARF. SOFA score, PF ratio, and quadrant infiltrations in chest radiography were good predictors of NIV failure in influenza infection with ARF.

Suttapanit K ，Boriboon J ，Sanguanwit P 《-》

Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study.

Azoulay E ，Pickkers P ，Soares M ，Perner A ，Rello J ，Bauer PR ，van de Louw A ，Hemelaar P ，Lemiale V ，Taccone FS ，Martin Loeches I ，Meyhoff TS ，Salluh J ，Schellongowski P ，Rusinova K ，Terzi N ，Mehta S ，Antonelli M ，Kouatchet A ，Barratt-Due A ，Valkonen M ，Landburg PP ，Bruneel F ，Bukan RB ，Pène F ，Metaxa V ，Moreau AS ，Souppart V ，Burghi G ，Girault C ，Silva UVA ，Montini L ，Barbier F ，Nielsen LB ，Gaborit B ，Mokart D ，Chevret S ，Efraim investigators and the Nine-I study group ... -  《-》