Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital
| Autor: | Clarice Tanaka, Maise Figueiroa, Teresa Cristina Francischetto Travaglia, Liria Yuri Yamauchi, Sidnei Bernardes, Carolina Fu |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Artificial ventilation
Male medicine.medical_specialty medicine.medical_treatment Intensive Care Unit Chest physiotherapy law.invention Cohort Studies Hospitals University Positive-Pressure Respiration law Positive airway pressure Medicine Humans Prospective Studies Simplified Acute Physiology Score Prospective cohort study Cohort Study lcsh:R5-920 Noninvasive Ventilation business.industry General Medicine Middle Aged Clinical Science Prognosis Intensive care unit Surgery Intensive Care Units Treatment Outcome Anesthesia Breathing Base excess Female lcsh:Medicine (General) business Respiratory Insufficiency |
| Zdroj: | Clinics Clinics, Volume: 67, Issue: 7, Pages: 767-772, Published: JUL 2012 Clinics; v. 67 n. 7 (2012); 767-772 Clinics; Vol. 67 Núm. 7 (2012); 767-772 Clinics; Vol. 67 No. 7 (2012); 767-772 Universidade de São Paulo (USP) instacron:USP Clinics, Vol 67, Iss 7, Pp 767-772 (2012) |
| ISSN: | 1980-5322 1807-5932 |
| Popis: | OBJECTIVES: To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis. METHODS: A prospective cohort study. RESULTS: Medical disorders (59%) and elective surgery (21%) were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55%) and a decreased level of consciousness (20%). The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5) versus four (3-7) days]; they had lower levels of pH, HCO3 and base excess, and the FiO2 level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26) days vs. 8 (5-14) days], as well as a higher mortality rate (9 vs. 51%). There was an association between failure and mortality, which had an odds ratio (95% CI) of 10.6 (5.93 -19.07). The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II$34, an inspiratory positive airway pressure level > 15 cmH2O and pH 34, pH |
| Databáze: | OpenAIRE |
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