[Use of noninvasive ventilation in critically ill patients]

The use of noninvasive ventilation has increased worldwide. Its mortality reducing benefit has been shown in several different conditions compared to invasive ventilation. Common counterarguments against the technique are its increased technical and caregiver requirements and increased mortality associated with treatment failure.

The aim of our work was to describe our experiences with noninvasive ventilation in the intensive care unit.

We reviewed patient data from the Respiratory Intensive Care unit of Semmelweis University operated from 2014 to 2016. Statistical analysis was performed by Mann-Whitney U test and Z-test; odds ratio was calculated with χ-square test.

Out of the 301 patients analyzed, 147 received noninvasive ventilation. Noninvasive failure rate was 24.5%. The highest failure rate was associated with immunodeficiency associated pneumonia, interstitial lung disease and pneumonia (71.4%, 33.3% and 31.6%), while noninvasive ventilation was the most successful in cardiogenic pulmonary edema and hypercapnic respiratory failure (0 and 16.7% failure rate). Treatment failure was associated with significantly higher mortality (33.3%) compared to patients initially ventilated invasively (24.5%) and patients successfully treated with noninvasive ventilation (3.6%), resulting in a 2.65-fold mortality increase in invasively ventilated patients (OR = 2.65, 95% CI = 1.305-5.374, p = 0.009), and a 13.33-fold mortality increase in noninvasive failure patients (OR = 13.33; 95% CI 3.278-54.238; p<0.001). Outcome scores did not predict noninvasive failure.

Noninvasive ventilation is a widely used, effective treatment mode which can improve the outcome in certain diseases compared to invasive ventilation. Noninvasive ventilation in incorrect indications could, however, lead to increased failure rates and mortality. Orv Hetil. 2018; 159(45): 1831-1837.