Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 3-4, Pages: 142-145
https://doi.org/10.2298/SARH1604142J
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General ward and pneumonia size as predictors of noninvasive ventilation failure
Joveš-Sević Biljana (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica + Medical Faculty, Novi Sad)
Obradović Dušanka 
(Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica + Medical Faculty, Novi Sad)
Stefanović Srđan (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica)
Batranović Uroš (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica)
Repić Jelena (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica)
Vukoja Marija (Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica + Medical Faculty, Novi Sad)
Introduction. Shortage of intensive care beds has led to more frequent use of
noninvasive ventilation (NIV) outside respiratory units, and data on NIV
efficacy and safety on general wards is lacking. Objective. The aim was to
identify potential predictors for NIV failure. Methods. This was a
retrospective analysis of patients treated with NIV at the Institute for
Pulmonary Diseases of Vojvodina from 2009 to 2013. Demographics, blood gases,
chest radiographs, setting, and outcomes were analyzed to identify predictors
of NIV failure. Results. A total of 138 patients (65% men, mean age 66 ± 11
years) were treated with NIV. Indications for NIV were acute exacerbation of
chronic obstructive pulmonary disease (85%) and cardiogenic pulmonary edema
(7%), as well as respiratory insufficiency related to obesity and central
hypoventilation (5%) and neuromuscular disease (3%). Rate of NIV failure was
34.8%. In 86 patients NIV was applied in the High Dependency Unit (HDU),
while 52 received NIV on the general ward. Baseline characteristics in terms
of gender, arterial blood gases, and the extent of consolidation on chest
radiographs were similar. Patients treated in HDU were younger (64.4 ± 1.2
vs. 69.4 ± 1.5 years, p < 0.001). NIV on the general ward compared to HDU had
higher rates of NIV failure (28/52 vs. 20/86, p < 0.001). Presence of
consolidation involving two or more quadrants on chest radiograph (55% vs.
29%, p < 0.001) was associated with NIV failure. When adjusted for age and
the extent of consolidation on chest radiograph, NIV failure was still less
likely in patients treated in HDU (OR 0.23, 95% CI 0.10-0.50). Conclusion.
Patients with consolidation on chest X-ray and patients treated with NIV
outside of dedicated respiratory units are at a higher risk for NIV failure.
Keywords: mechanical ventilation, respiratory care units, noninvasive ventilation, respiratory insufficiency