Early failure of noninvasive ventilation in chronic obstructive pulmonary disease with acute hypercapnic respiratory failure
Abstract
Noninvasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure is considered a first-line therapy. However, patients who fail NIV and then require invasive mechanical ventilation have been found to have higher mortality than patients initially treated with invasive mechanical ventilation. We tried to find parameters associated with early NIV failure (need for intubation or death <24 h of starting NIV) in patients presenting to the ED with acute exacerbation of COPD. A retrospective analysis was conducted of the medical records of 218 patients with acute exacerbation of COPD visiting Asan Medical Center and managed with NIV during their stay in the ED from January 2007 to December 2013. NIV was successful in 200 (91.7%) and 18 (8.3%) had early NIV failure. Of the variables obtained before NIV treatment, heart rate (≥120/min: OR 2.5, 95% CI 1.2-7.0) and pH (7.25-7.29: OR 2.1, 95% CI 1.0-8.8; <7.25: OR 11.7, 95% CI 3.5-38.6) were significant factors associated with early NIV failure. Of the variables obtained after 1 h of NIV treatment, heart rate (≥120/min: OR 7.5, 95% CI 2.3-24.3) and pH (7.25-7.29: OR 4.7, 95% CI 1.5-15.1; <7.25: OR 20.9, 95% CI 5.4-61.2) were still significant. The presence of tachycardia and severe acidosis before NIV treatment and persistence of tachycardia and severe acidosis after 1 h of NIV treatment were associated with early NIV failure.
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Previous studies suggested that misuse or rejection of medication or NIV can be influenced by psychological factors such as anxiety, depression, health beliefs, and cognitive impairment.
“Previous studies suggested that the misuse or rejection of medication or NIV can be influenced by some psychological factors such as anxiety, depression, health beliefs, and cognitive impairment (27–29); the unacknowledged recognition of the illness; and the use of different devices and medications due to comorbidities (30–32).”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [30]
No study has identified the individual psychological factors that increase the risk of rejection or improper use of NIV.
“No study has identified the individual psychological factors that increase the risk of rejection or improper use of NIV.”
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Volpato, E., Banfi, P., & Pagnini, F. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001053 · Cited by 24 · see citing works
“Nevertheless, only a few studies have paid attention to adherence to NIV in COPD people, and most of them have focused only on early NIV failure (33,34) or on the quantification of adherence (35).”
BackgroundVolpato, E., Banfi, P., & Pagnini, F. (2017) · Trials · doi:10.1186/s13063-017-1802-1 · Cited by 18 · see citing works
“tubation or death within 24–48 h of starting NIV) [30, 31],”
Background
- Authors
- Ko, B. S., Ahn, S., Lim, K. S., Kim, W. Y., Lee, Y.-S., & Lee, J. H.
- Affiliations
- Asan Medical Center (KR)
- Corresponding author
- Ahn, Shin
- Venue
- Internal and Emergency Medicine
- Published
- 2015-09-04
- Volume
- 10
- Issue
- 7
- Pages
- 855-860
- ISSN
- 1828-0447 (ISSN-L)
- 1970-9366
- OpenAlex
- W1234751227
- Cited by
- 27
- References
- 25
- Citations by year
- 2026: 3 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 5 · 2016: 2 · 2015: 1
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Internal and Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- non-invasive ventilation, NIV failure, chronic obstructive pulmonary disease, COPD exacerbations, hypercapnic respiratory failure, tachycardia, acidosis, risk factors, emergency department, invasive mechanical ventilation
- MeSH terms
- Aged, Blood Gas Analysis, Female, Humans, Hypercapnia, Intensive Care Units, Male, Middle Aged, Respiration, Artificial, Respiratory Insufficiency, Retrospective Studies, Multivariate Analysis, Logistic Models, Pulmonary Disease, Chronic Obstructive, Noninvasive Ventilation
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