Non-invasive positive pressure ventilation in lung transplant recipients with acute respiratory failure: Beyond the perioperative period
| Autor: | Ali Ataya, Samuel P. Wiles, Madhu Sasidhar, Tarik Hanane, Mourad H. Senussi, Xiaofeng Wang, Charles Lane |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Lung Diseases Male medicine.medical_specialty Multivariate analysis medicine.medical_treatment Critical Care and Intensive Care Medicine Logistic regression Hypoxemia Positive-Pressure Respiration 03 medical and health sciences 0302 clinical medicine medicine Humans Intubation Acute respiratory failure Hospital Mortality Postoperative Period 030212 general & internal medicine Hypoxia Perioperative Period Survival rate APACHE Aged Probability Retrospective Studies Respiratory Distress Syndrome Lung business.industry Perioperative Middle Aged Transplant Recipients respiratory tract diseases Hospitalization medicine.anatomical_structure 030228 respiratory system Emergency medicine Female medicine.symptom Respiratory Insufficiency business Lung Transplantation |
| Zdroj: | Journal of Critical Care. 47:287-294 |
| ISSN: | 0883-9441 |
| DOI: | 10.1016/j.jcrc.2018.07.028 |
| Popis: | Purpose The purpose of this study is to evaluate outcomes in MICU lung transplant recipients with acute respiratory failure treated with non-invasive positive pressure ventilation (NPPV) and identify factors associated with NPPV failure (need for intubation). Methods Retrospective chart review of all lung transplant recipients who were admitted with acute respiratory failure to the MICU from January 2009–August 2016 was completed. Logistic regression analysis was performed to determine which factors were independently associated with NPPV failure. Results Of 156 patients included in the study, 125 (80.1%) were tried on NPPV. Sixty-eight (54.4%) were managed successfully with NPPV with a hospital survival rate of 94.1%. Subjects who failed NPPV had higher hospital mortality, similar to those intubated from the outset (15 [48.3%]; 22 [38.6%], p = .37). In multivariate analyses, APACHE III scores >78 (9.717 [3.346, 28.22]) and PaO2/FiO2 ≤ 151 (4.54 [1.72, 11.99]) were associated with greater likelihood of NPPV failure. There was no difference in NPPV failure based on the presence of BOS. In patients with high severity of illness, there was no difference in mortality between initial IMV and NPPV failure when stratified on the basis of hypoxemia (PaO2/FiO2 > 151, p -value 0.34; PaO2/FiO2 ≤ 151, p-value 0.99). Conclusions NPPV is a viable option for lung transplant recipients with acute respiratory failure. Extreme caution should be exercised when used in patients with high severity of illness (APACHE III >78) and/or severe hypoxemia (PaO2/FiO2 ≤ 151). |
| Databáze: | OpenAIRE |
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