Friday November 7, 2008
Factors predicting successful noninvasive ventilation in acute lung injury

Noninvasive ventilation (NIV) has been successfully used to treat various forms of acute respiratory failure. It remains unclear whether NIV has potential as an effective therapeutic method in patients with acute lung injury (ALI). The aims of this study were to determine factors predicting the need for endotracheal intubation in ALI patients treated with NIV, and to promote the selection of patients suitable for NIV.

Results: A total of 47 patients with ALI received NIV, and 33 patients (70%) successfully avoided endotracheal intubation.

Patients who required endotracheal intubation had a

• significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II score
• a significantly higher Simplified Acute Physiology Score (SAPS) II
• a significantly lower arterial pH

The respiratory rate decreased significantly within 1 h of starting NIV only in patients successfully treated with NIV.

An APACHE II score of more than 17 (P = 0.022) and a respiratory rate of more than 25 breaths/min after 1 h of NIV (P = 0.024) were independent factors associated with the need for endotracheal intubation.

Patients who avoided endotracheal intubation had a significantly lower ICU mortality rate and in-hospital mortality rate than patients who required endotracheal intubation.

Conclusion: We determined an APACHE II score of more than 17 and a respiratory rate of more than 25 breaths/min after 1 h of NIV as factors predicting the need for endotracheal intubation in ALI patients treated with NIV.


Above pearl is contributed by:

Tony Halat, MD
Clinical Instructor in Medicine
Department of Medicine,
The Methodist Hospital
Weill Medical College, Cornell University



Reference: click to get article

Factors predicting successful noninvasive ventilation in acute lung injury - Journal of Anesthesia, Volume 22, Number 3 / August, 2008, 201-206