Early detection of non-invasive ventilation failure among acute respiratory failure patients in the emergency department
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(2020) 20:80
RESEARCH ARTICLE
Open Access
Early detection of non-invasive ventilation failure among acute respiratory failure patients in the emergency department W. Liengswangwong, C. Yuksen* , T. Thepkong, P. Nakasint and C. Jenpanitpong
Abstract Background: Non-invasive mechanical ventilation (NIV) has become an alternative to an invasive artificial airway for the management of acute respiratory failure (ARF). NIV failure causes delayed intubation, which eventually has been associated with increased morbidity and mortality. This study aimed to develop the clinical scoring system of NIV failure in ARF patients. Methods: This study was a diagnostic, retrospectively cross-sectional, and exploratory model at the Emergency Medicine Department in Ramathibodi Hospital between February 2017 and December 2017. We included all of the acute respiratory failure patients aged > 18 years and received non-invasive ventilation (NIV). Clinical factors associated with NIV failure were recorded. The predictive model and prediction score for NIV failure were developed by multivariable logistic regression analysis. Result: A total of 329 acute respiratory failure patients have received NIV success (N = 237) and failure (N = 92). This study showed that NIV failure was associated with heart rate > 110 bpm, systolic BP < 110 mmHg, SpO2 < 90%, arterial pH < 7.30 and serum lactate. The clinical scores were classified into three groups: low, moderate, and high. Conclusion: We suggested that the novel clinical scoring of the NIV failure in this study may use as a good predictor for NIV failure in the emergency room. Keywords: NIV failure, Predictive score
Background Acute respiratory failure (ARF) was a steady increase in the number of hospitalizations at an average annual rate of 11.3% in 2001 to 2009 with a decrease in inpatient mortality in the United States [1]. In Thailand, ARF was increased from 6.99 people per 100,000 in 2011 to 8.98 people per 100,000 in 2014 [2]. ARF characterized by the impaired respiratory system to exchange gases and to oxygenate the blood, resulting in hypoxia with or without hypercapnia [2]. Two main mechanisms of ARF * Correspondence: [email protected] Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama 6 Road, Phayathai, Ratchathewi, Bangkok 10400, Thailand
include failure in pulmonary ventilation caused by neuromuscular diseases, chest wall deformities, obstructive pulmonary diseases, and failure in gas exchanges caused by adult acute respiratory distress syndrome, neonatal respiratory distress syndrome, acute cardiogenic pulmonary edema, severe status asthmaticus, pneumonia, airspace collapse (atelectasis) and pulmonary embolism [3]. The clinical signs and symptoms of patients with ARF refer to the two main manifestations of pulmonary diseases, including arterial hypercapnia and hypoxemia. Noninvasive ventilation (NIV) refers to the delivery of mechanical ventilation without using an invasive artificial airway (endotracheal tube or trache
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