Noninvasive ventilation in relapse of acute respiratory failure outside ICU

Killen Briones Claudett¹*, Mónica Briones Claudett¹, Miguel Chung Sang¹, Hector Alajo Maiguashca¹, Diego Cruz Pico², Michel Grunauer Andrade², Antonio Esquinas Rodriguez³ and Gumersindo Gonzalez Diaz³

¹Pneumology and Intensive Care Unit Department, Military Hospital, Guayaquil – Ecuador.

²Medicine Faculty of the University San Francisco. Quito – Ecuador.

³Intensive Care Unit and Pneumology Services, J. M. Morales Meseguer Hospital, Murcia - Spain.

*Corresponding author. E-mail: kyllenb@ecutel.net, kyllenbrio@yahoo.com.

Tel: +59342897238;   +59387102550. Fax: + 59342897238

Accepted 29 October, 2009

   Abstract

The transfer of patients to the ICU from the General Ward could be a frequent issue of major concern in many hospitals around the world. We accessed the effectiveness of NIMV protocol outside ICU in sub-group of patients with relapse of acute respiratory failure and we also determined the factors associated with ICU transfer. This work is a prospective observational study. A total of 525 patients were treated of acute respiratory failure during this period of three years study. Of this, 353 (67.2%) were managed with standard therapy and 46 (8.7%) were presented with relapse and required NIMV outside ICU. The most frequent diagnoses were: COPD 22 (47.8%), CAP 13 (28.3%), CHF 5 (10.9%), asthma 4 (8.7), and diffuse interstitial pulmonary disease 2 (4.3%). Levels of IPAP were 13.5 ± 2.1 and EPAP 6.1 ± 0.8. Respiratory acidosis, the most recent finding, was (82.6%); transfer to the ICU, 5 (10.9%), and need for endotracheal intubation, 3 (6.5%).  2 (4.3%) patients in the study died and 44 (95.7%) patients were alive. The variables associated with transfer to the ICU were: IPAP level (p = 0.005), EPAP level (p = 0.03), antibiotic regimen changes (p = 0.01), and elevated HR (p = 0.04) and acid-base disorders (p = 0, 10). Cumulative survival at 13 months was 86% and in 36 months it was 73% by the Kaplan-Meier method. We identified a sub-group of patients who can benefit from the early application of NIMV protocol outside ICU after the relapse of acute respiratory failure. However, a multi-centre study that involves a greater number of patients with these characteristic could be required.

Key words: Noninvasive mechanical ventilation, inspiratory positive airway pressure, emergency room, relapses, transfers UCI, failure.