Failure of Non-Invasive Ventilation in Acute Lung Injury Patients
Author Information
Author(s): Rana Sameer, Jenad Hussam, Gay Peter C, Buck Curtis F, Hubmayr Rolf D, Gajic Ognjen
Primary Institution: Mayo Clinic, Rochester, Minnesota, USA
Hypothesis
What are the outcomes of acute lung injury patients treated with non-invasive positive pressure ventilation and what risk factors predict failure?
Conclusion
Non-invasive positive pressure ventilation should be used cautiously in acute lung injury patients with shock, metabolic acidosis, or severe hypoxemia.
Supporting Evidence
- 70.3% of patients treated with NIPPV failed the therapy.
- All patients with shock failed NIPPV.
- Patients who failed NIPPV had a higher observed mortality than predicted mortality.
Takeaway
This study found that many patients with a serious lung condition didn't do well with a certain type of breathing support, especially if they were very sick.
Methodology
This was an observational cohort study conducted in two intensive care units, analyzing patients with acute lung injury treated with non-invasive positive pressure ventilation.
Potential Biases
The decision to intubate was left to the treating physicians, which may have introduced bias in patient selection.
Limitations
The study was conducted at a single center, limiting generalizability, and the observational design does not establish cause and effect.
Participant Demographics
Patients included were critically ill medical patients with acute lung injury, primarily diagnosed with pneumonia.
Statistical Information
P-Value
p<0.01
Confidence Interval
95% CI 1.03 to 0.07 for metabolic acidosis; 95% CI 1.01 to 1.05 for severe hypoxemia
Statistical Significance
p<0.01
Digital Object Identifier (DOI)
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