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Utility of respiratory ward‐based NIV in acidotic hypercapnic respiratory failure
Author(s) -
Dave Chirag,
Turner Alice,
Thomas Ajit,
Beauchamp Ben,
Chakraborty Biman,
Ali Asad,
Mukherjee Rahul,
Banerjee Dev
Publication year - 2014
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12366
Subject(s) - medicine , logistic regression , intubation , cohort , respiratory system , respiratory failure , ventilation (architecture) , respiratory disease , emergency medicine , anesthesia , lung , mechanical engineering , engineering
Background and objective We sought to elicit predictors of in‐hospital mortality for first and subsequent admissions with acidotic hypercapnic respiratory failure ( AHRF ) in a cohort of chronic obstructive pulmonary disease patients who have undergone ward‐based non‐invasive ventilation ( NIV ), and identify features associated with long‐term survival. Methods Analysis of prospectively collected data at a single centre on patients undergoing NIV for AHRF between 2004 and 2009. Predictors of in‐hospital mortality and intubation were sought by logistic regression and predictors of long‐term survival by C ox regression. Results Initial p H exhibited a threshold effect for in‐hospital mortality at p H 7.15. This relationship remained in patients undergoing their first episode of AHRF . In both first and subsequent admissions, a p H threshold of 7.25 at 4 h was associated with better prognosis ( P = 0.02 and P = 0.04 respectively). In second or subsequent episodes of AHRF , mortality was lower and predicted only by age ( P = 0.002) on multivariate analysis. Conclusions NIV could be used on medical wards for patients with p H 7.16 or greater on their first admission, although more conservative values should continue to be used for those with a second or subsequent episodes of AHRF .