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A2549 - Risk Factors and Clinical Outcomes of Noninvasive Positive Pressure Ventilation Failure After Extubation in Critically Ill Adult Patients
Author Block: Y. Chen1, Y. Chen1, I. Wang1, C. Chen2, J. Chien3, J. Jerng4, C. Yu5; 1Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan, Yun-Lin, Taiwan, 2National Taiwan Univ Hospital Yun-Lin Branch, Douliou City Yunlin 640, Taiwan, 3National Taiwan University Hospital, Taipei, Taiwan, Douliu City 640, Taiwan, 4National Taiwan University Hospital, Taipei, Taiwan, 5Natl Taiwan Univ Hosp, Taipei10016, Taiwan.
Rationale: We aim to investigate the use of noninvasive positive pressure ventilation (NIPPV) after extubation in intensive care units (ICUs) and to identify the risk factors of NIPPV failure and also evaluate the associated clinical outcomes. Methods: We retrospectively review adult patients (age >20 years) admitted to ICUs who received NIPPV support within 48 hours after extubation in a single institute between December 2014 and September 2016. The clinical characteristics, laboratory data and respiratory parameters were recorded. The primary outcome was NIPPV failure (defined as re-intubation or death after NIPPV use in ICU). Results: A total of 1496 patients admitted to ICU and received mechanical ventilation were screened and 99 adult patients (6.61%) required NIPPV after post-extubation were included for analysis. Of them, the overall mean age was 74 + 11 years, and 58.6% of patients were male. The failure rate of NIPPV support was 32.3% and also associated with higher ICU mortality (12.5% vs. 0%, p=0.01). The respiratory parameters: Pi max (-27.2 vs -32.3 cmH2O, p=0.046), Pe max (25.7 vs, 40.0 cmH2O, p=0.007), cough power (sputum could be expectorated to the tube, 34.4% vs. 65.7%, p=0.003), medical research council (MRC) scale for muscle strength (18.8 vs 23.2, p=0.004), NIPPV applied indication (indicative for new respiratory distress vs, preventive use, p=0.004) and laboratory data: lower Albumin (2.68 vs.3.04 g/dl, p=0.031), lower Hb (9.4 vs. 10.3 g/dl, p=0.052) and lower HCO3 ( 22.7 vs. 25.6 mmHg ,p=0.043) level were associated with NIPPV failure. Further logistic regression analysis showed that only poor cough power (Odd Ratio [OR]:10.49, 95% CI 1. 1.545-71.297, p=0.016), and indicative NIPPV use (OR: 11.170, 95% CI: 1.432-87.148, p=0.021) were the independent risk factors for NIPPV failure. The outcomes of post-extubation NIPPV use in ICU were as followings: weaning off NIPPV in ICU (49.5%), re-intubation (29.3%), prolong NIPPV use beyond ICU (18.2%) and death in ICU (3.0%). Conclusions: The NIPPV failure was occurred in one-third critically ill patients who received NIPPV as post-extubation support. Poor cough power and indicative NIPPV use for new respiratory distress are the predictive risk factors.