| Abstract | OBJECTIVE: In randomized studies of heterogeneous patients with hypoxemic acute respiratory failure, noninvasive positive pressure ventilation (NPPV) was associated with a significant reduction in endotracheal intubation. The role of NPPV in patients with acute respiratory distress syndrome (ARDS) is still unclear. The objective was to investigate the application of NPPV as a first-line intervention in patients with early ARDS, describing what happens in everyday clinical practice in centers having expertise with NPPV. DESIGN: Prospective, multiple-center cohort study. SETTING: Three European intensive care units having expertise with NPPV. PATIENTS: Between March 2002 and April 2004, 479 patients with ARDS were admitted to the intensive care units. Three hundred and thirty-two ARDS patients were already intubated, so 147 were eligible for the study. INTERVENTIONS: Application of NPPV. MEASUREMENTS AND MAIN RESULTS: NPPV improved gas exchange and avoided intubation in 79 patients (54%). Avoidance of intubation was associated with less ventilator-associated pneumonia (2% vs. 20%; p < .001) and a lower intensive care unit mortality rate (6% vs. 53%; p < .001). Intubation was more likely in patients who were older (p = .02), had a higher Simplified Acute Physiology Score (SAPS) II (p < .001), or needed a higher level of positive end-expiratory pressure (p = .03) and pressure support ventilation (p = .02). Only SAPS II >34 and a Pao2/Fio2 < or =175 after 1 hr of NPPV were independently associated with NPPV failure and need for endotracheal intubation. CONCLUSIONS: In expert centers, NPPV applied as first-line intervention in ARDS avoided intubation in 54% of treated patients. A SAPS II >34 and the inability to improve Pao2/Fio2 after 1 hr of NPPV were predictors of failure. |
| Authors | Massimo Antonelli, Giorgio Conti, Antonio Esquinas, Luca Montini, Salvatore Maurizio Maggiore, Giuseppe Bello, Monica Rocco, Riccardo Maviglia, Mariano Alberto Pennisi, Gumersindo Gonzalez-Diaz, Gianfranco Umberto Meduri
(Affiliation: Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy. m.antonelli at rm.unicatt.it)
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| Journal | Critical care medicine
(Crit Care Med)
Vol. 35
Issue 1
Pg. 18-25
(Jan 2007)
ISSN: 0090-3493 United States |
| PMID | 17133177
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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| Topics |
- Adult
- Aged
- Analysis of Variance
- Blood Gas Analysis
- Critical Care
(methods, statistics & numerical data)
- Cross Infection
(epidemiology, etiology)
- Decision Trees
- Female
- Hospital Mortality
- Humans
- Intubation, Intratracheal
(adverse effects)
- Italy
(epidemiology)
- Logistic Models
- Male
- Middle Aged
- Patient Selection
- Physician's Practice Patterns
(statistics & numerical data)
- Pneumonia
(epidemiology, etiology)
- Positive-Pressure Respiration
(adverse effects, methods, statistics & numerical data)
- Prospective Studies
- Pulmonary Gas Exchange
- ROC Curve
- Respiratory Distress Syndrome, Adult
(etiology, mortality, therapy)
- Spain
(epidemiology)
- Survival Analysis
- Treatment Outcome
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