Predictors of outcome for patients with severe respiratory failure requiring non invasive mechanical ventilation

V. Conti, G. Paone, C. Mollica, A. Sebastiani, A. Mannocci, G. La Torre, V. Cardaci, I. Cammarella, G. Puglisi, G. Brunetti, M.G. Alma, C. Terzano

Department of Respiratory Diseases, IRCCS San Raffaele – Pisana, Rome Italy. vittoria.conti@gmail.com

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• Respiratory Medicine

OBJECTIVE: Failure to identify patients in whom non-invasive ventilation (NIV) would be unsuccessful may cause inappropriate delay in intubation. Aim of this study was to determine predictors of NIV failure.

PATIENTS AND METHODS: We retrospectively evaluated COPD patients, undergoing NIV for at least 12h because of hypercapnic acute respiratory failure.
Univariable and multivariable analyses were performed on: age, gender, APACHE II and GCS, gas exchange at admission, during NIV and at discharge/death, length of stay. ROC analysis for pH START and APACHE II were performed.

RESULTS: Among 201 individuals enrolled, NIV failed in 50. In the logistic regression model only APACHE II was found to have an independent effect on the outcome (p < 0.0001, OR 1.179, 95% CI 1.101-1.263 as quantitative variable; p < 0.0001, OR 3.753, 95% CI 1.798-7.835, as qualitative variable, > 20.5).

CONCLUSIONS: APACHE II may be a crucial parameter in predicting NIV failure; further multicentric studies are needed to better define NIV indications.

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