Related Experiment Videos
Nurse-Performed Bedside Respiratory Mechanics for Early Prediction of Non-Invasive Ventilation Failure: A Prospective
Longfang Pan1, Xiaoqing Zhong1, Qianru Zhao1
1Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Background:
Non-invasive ventilation (NIV) failure is associated with increased mortality, underscoring the need for early predictors to guide timely intervention.
Aim:
To explore the predictive value of ICU nurse-measured tidal-breathing maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak inspiratory flow (PIF) and peak expiratory flow (PEF) for NIV failure.
Study Design:
This prospective observational study enrolled patients receiving NIV as first-line therapy in a Chinese ICU. ICU nurses measured tidal-breathing MIP, MEP, PIF and PEF before NIV initiation. NIV failure was defined as the requirement of intubation.
Results:
Among 102 enrolled patients, 17 (17%) experienced NIV failure. The failure group showed significantly higher respiratory parameters: MIP (16.5 ± 5.4 vs. 10.2 ± 3.7 cmH2O), MEP (17.6 ± 7.1 vs. 11.0 ± 4.6 cmH2O), PIF (59 ± 21 vs. 38 ± 14 L/Min) and PEF (57 ± 23 vs. 37 ± 15 L/Min) (All p < 0.001). AUCs for predicting NIV failure were 0.83 (95% CI: 0.74-0.89) for MIP, 0.81 (95% CI: 0.72-0.88) for MEP, 0.79 (95% CI: 0.70-0.87) for PIF and 0.77 (95% CI: 0.68-0.85) for PEF. The adjusted odds ratio for NIV failure was 1.42 (95% CI: 1.10-1.82, p < 0.001) per one-unit increase in MIP, 1.30 (95% CI: 1.03-1.65, p = 0.027) per one-unit increase in MEP, 1.05 (95% CI: 0.99-1.11, p = 0.076) per one-unit increase in PIF and 1.03 (95% CI: 0.99-1.09, p = 0.180) per one-unit increase in PEF.
Conclusions:
Nurse-performed bedside tidal-breathing MIP, MEP, PIF and PEF may predict NIV failure. Elevated baseline MIP and MEP may increase the risk of NIV failure in critically ill patients.
Relevance To Clinical Practice:
Nurse-conducted bedside tidal-breathing MIP and MEP measurement at NIV initiation supports rapid risk stratification. Identifying patients with elevated parameters enables intensified monitoring, timely ventilator adjustment and early intubation preparation, avoiding delayed interventions and optimising patient outcomes.
Related Concept Videos
Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Mechanical Ventilation I: Indication and Settings
Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like asthma or COPD,...