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VOLUME 19 , ISSUE 10 ( 2015 ) > List of Articles

RESEARCH ARTICLE

A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome

Soumik Chaudhuri, Inderpaul Sehgal

Keywords : Acute hypoxemic respiratory failure, acute lung injury, acute respiratory distress syndrome, mechanical ventilation, noninvasive ventilation

Citation Information : Chaudhuri S, Sehgal I. A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome. Indian J Crit Care Med 2015; 19 (10):593-599.

DOI: 10.4103/0972-5229.167037

License: CC BY-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2015; The Author(s).


Abstract

Aim: There is sparse data on the role of noninvasive ventilation (NIV) in acute respiratory distress syndrome (ARDS) from India. Herein, we report our experience with the use of NIV in mild to moderate ARDS. Materials and Methods: This was a prospective observational study involving consecutive subjects of ARDS treated with NIV using an oronasal mask. Patients were monitored clinically with serial arterial blood gas analysis. The success of NIV, duration of NIV use, Intensive Care Unit stay, hospital mortality, and improvement in clinical and blood gas parameters were assessed. The success of NIV was defined as prevention of endotracheal intubation. Results: A total of 41 subjects (27 women, mean age: 30.9 years) were included in the study. Tropical infections followed by abdominal sepsis were the most common causes of ARDS. The use of NIV was successful in 18 (44%) subjects, while 23 subjects required intubation. The median time to intubation was 3 h. Overall, 19 (46.3%) deaths were encountered, all in those requiring invasive ventilation. The mean duration of ventilation was significantly higher in the intubated patients (7.1 vs. 2.6 days, P = 0.004). Univariate analysis revealed a lack of improvement in PaO 2 /FiO 2 at 1 h and high baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) as predictors of NIV failure. Conclusions: Use of NIV in mild to moderate ARDS helped in avoiding intubation in about 44% of the subjects. A baseline APACHE II score of >17 and a PaO 2 /FiO 2 ratio <150 at 1 h predicts NIV failure.


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  1. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA 2012;307:2526-33.
  2. Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India. Chest 2006;130:724-9.
  3. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342:1301-8.
  4. Brochard L, Mancebo J, Elliott MW. Noninvasive ventilation for acute respiratory failure. Eur Respir J 2002;19:712-21.
  5. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817-22.
  6. Agarwal R, Gupta R, Aggarwal AN, Gupta D. Noninvasive positive pressure ventilation in acute respiratory failure due to COPD vs other causes: Effectiveness and predictors of failure in a respiratory ICU in North India. Int J Chron Obstruct Pulmon Dis 2008;3:737-43.
  7. Sharma S, Agarwal R, Aggarwal AN, Gupta D, Jindal SK. A survey of noninvasive ventilation practices in a respiratory ICU of North India. Respir Care 2012;57:1145-53.
  8. Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Non-invasive ventilation in acute cardiogenic pulmonary oedema. Postgrad Med J 2005;81:637-43.
  9. Agarwal R, Aggarwal AN, Gupta D. Role of noninvasive ventilation in acute lung injury/acute respiratory distress syndrome: A proportion meta-analysis. Respir Care 2010;55:1653-60.
  10. Luo J, Wang MY, Zhu H, Liang BM, Liu D, Peng XY, et al. Can non-invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta-analysis. Respirology 2014;19:1149-57.
  11. Agarwal R, Handa A, Aggarwal AN, Gupta D, Behera D. Outcomes of noninvasive ventilation in acute hypoxemic respiratory failure in a respiratory intensive care unit in north India. Respir Care 2009;54:1679-87.
  12. Agarwal R, Nath A, Gupta D. Noninvasive ventilation in Plasmodium vivax related ALI/ARDS. Intern Med 2007;46:2007-11.
  13. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149(3 Pt 1):818-24.
  14. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  15. Klockars AJ, Hancock GR. Scheffé′s more powerful F-protected post-hoc procedure. J Educ Behav Stat 2000;25:13-9.
  16. Chan YH. Biostatistics 301. Repeated measurement analysis. Singapore Med J 2004;45:354-68.
  17. Zhan Q, Sun B, Liang L, Yan X, Zhang L, Yang J, et al. Early use of noninvasive positive pressure ventilation for acute lung injury: A multicenter randomized controlled trial. Crit Care Med 2012;40:455-60.
  18. Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G, et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 2007;35:18-25.
  19. Nicolini A, Tonveronachi E, Navalesi P, Antonelli M, Valentini I, Melotti RM, et al. Effectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: A multicenter study. Minerva Anestesiol 2012;78:1333-40.
  20. BouAkl I, Bou-Khalil P, Kanazi G, Ayoub C, El-Khatib M. Weaning from mechanical ventilation. Curr Opin Anaesthesiol 2012;25:42-7.
  21. Cheung TM, Yam LY, So LK, Lau AC, Poon E, Kong BM, et al. Effectiveness of noninvasive positive pressure ventilation in the treatment of acute respiratory failure in severe acute respiratory syndrome. Chest 2004;126:845-50.
  22. Yoshida Y, Takeda S, Akada S, Hongo T, Tanaka K, Sakamoto A. Factors predicting successful noninvasive ventilation in acute lung injury. J Anesth 2008;22:201-6.
  23. Rocker GM, Mackenzie MG, Williams B, Logan PM. Noninvasive positive pressure ventilation: Successful outcome in patients with acute lung injury/ARDS. Chest 1999;115:173-7.
  24. Ambrosino N. Noninvasive mechanical ventilation in acute respiratory failure. Monaldi Arch Chest Dis 1996;51:514-8.
  25. Ambrosino N. Noninvasive mechanical ventilation in acute respiratory failure. Eur Respir J 1996;9:795-807.
  26. Wood KA, Lewis L, Von Harz B, Kollef MH. The use of noninvasive positive pressure ventilation in the emergency department: Results of a randomized clinical trial. Chest 1998;113:1339-46.
  27. Rana S, Jenad H, Gay PC, Buck CF, Hubmayr RD, Gajic O. Failure of non-invasive ventilation in patients with acute lung injury: Observational cohort study. Crit Care 2006;10:R79.
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