Failure of non-invasive respiratory support after 6 hours from initiation is associated with ICU mortality

PLoS One. 2021 Apr 30;16(4):e0251030. doi: 10.1371/journal.pone.0251030. eCollection 2021.

Abstract

A previous study has shown that late failure (> 48 hours) of high-flow nasal cannula (HFNC) was associated with intensive care unit (ICU) mortality. The aim of this study was to investigate whether failure of non-invasive respiratory support, including HFNC and non-invasive positive pressure ventilation (NPPV), was also associated with the risk of mortality even if it occurs in the earlier phase. We retrospectively analyzed 59 intubated patients for acute respiratory failure due to lung diseases between April 2014 and June 2018. We divided the patients into 2 groups according to the time from starting non-invasive ventilatory support until their intubation: ≤ 6 hours failure and > 6 hours failure group. We evaluated the differences in the ICU mortality between these two groups. The multivariate logistic regression analysis showed the highest mortality in the > 6 hours failure group as compared to the ≤ 6 hours failure group, with a statistically significant difference (p < 0.01). It was also associated with a statistically significant increased 30-day mortality and decreased ventilator weaning rate. The ICU mortality in patients with acute respiratory failure caused by lung diseases was increased if the time until failure of HFNC and NPPV was more than 6 hours.

MeSH terms

  • Aged
  • Cannula / adverse effects*
  • Female
  • Humans
  • Intensive Care Units / standards*
  • Intensive Care Units / statistics & numerical data
  • Intubation / adverse effects*
  • Male
  • Middle Aged
  • Noninvasive Ventilation / adverse effects*
  • Oxygen Inhalation Therapy / adverse effects*
  • Positive-Pressure Respiration / adverse effects*
  • Respiratory Distress Syndrome / mortality*
  • Respiratory Distress Syndrome / pathology
  • Respiratory Distress Syndrome / therapy
  • Retrospective Studies
  • Time Factors
  • Treatment Failure

Grants and funding

The authors received no specific funding for this work.