Journal of the Chinese Medical Association
Volume 71, Issue 8 , Pages 392-398, August 2008

Predictors of Successful Noninvasive Ventilation Treatment for Patients Suffering Acute Respiratory Failure

  • Ming-Shian Lin

      Affiliations

    • Department of Chest Medicine, Chia-Yi Christian Hospital, Chia-Yi, Tainan, Taiwan, R.O.C.
    • ,
  • How-Ran Guo

      Affiliations

    • Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.
    • Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.
    • ,
  • Ming-Hua Huang

      Affiliations

    • Department of Respiratory Therapy, Chia-Yi Christian Hospital, Chia-Yi, Tainan, Taiwan, R.O.C.
    • ,
  • Cheng-Ren Chen

      Affiliations

    • Department of Chest Medicine, Chia-Yi Christian Hospital, Chia-Yi, Tainan, Taiwan, R.O.C.
    • ,
  • Chen-Long Wu

      Affiliations

    • Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.
    • Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.
    • Department of Occupational Medicine, Chi-Mei Foundation Medical Center, Tainan, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chen-Long Wu, Department of Environmental and Occupational Health, National Cheng Kung University, 138, Sheng-Li Road, Tainan 704, Taiwan, R.O.C.

Received 21 September 2007; accepted 24 July 2008.

Background

To identify predictors of successful noninvasive ventilation (NIV) treatment for patients with acute respiratory failure.

Methods

This was a prospective intervention study of the intensive care unit of a teaching hospital in Chia-Yi, Taiwan. Patients were enrolled if they had acute respiratory failure and had been admitted to the intensive care unit of our hospital between October 1, 2004 and September 30, 2005 inclusively.

Results

All 86 patients who satisfied the study's inclusion criteria agreed to participate in the study, and each patient was followed-up until the discontinuation of NIV treatment or their death. We measured the Acute Physiology and Chronic Health Evaluation (APACHE) II score prior to their treatment and also conducted serial measurements of respiratory rate (RR), tidal volume, rapid shallow breathing index, maximal inspiratory pressure (PImax), and maximal expiratory pressure (PEmax) prior to, and 30 minutes and 60 minutes subsequent to NIV treatment (denoted by, respectively, the subscripted numbers 0, 30 and 60). NIV treatment was determined as being successful for 55 patients (the success group, for which individuals endotracheal intubation was avoided) and as being a failure for 31 patients (the failure group). APACHE II scores prior to treatment, PImax30 (PImax 30 minutes subsequent to NIV), RR30(RR 30 minutes subsequent to NIV), and RR60 (RR 60 minutes subsequent to NIV) were all significantly lower for the success group than for the failure group. The success group also had significantly better values for RR during the first 30 minutes of NIV treatment and for PEmax during the first 60 minutes of NIV treatment compared to individuals from the failure group.

Conclusion

APACHE II scores recorded prior to NIV treatment, PImax30, R30, RR60, as well as improvements to RR during the first 30 minutes of NIV treatment and to PEmax during the first 60 minutes of NIV treatment were predictors of successful NIV treatment for patients suffering from acute respiratory failure. Such parameters may be helpful in selecting patients to receive NIV treatment and also for deciding when early termination of the treatment is appropriate.

Key Words:  acute respiratory failure , APACHE II , noninvasive ventilation , rapid shallow breathing index , respiratory rate

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PII: S1726-4901(08)70089-3

doi:10.1016/S1726-4901(08)70089-3

Journal of the Chinese Medical Association
Volume 71, Issue 8 , Pages 392-398, August 2008

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