Journal of
Clinical Medicine and Research

  • Abbreviation: J. Clin. Med. Res.
  • Language: English
  • ISSN: 2141-2235
  • DOI: 10.5897/JCMR
  • Start Year: 2009
  • Published Articles: 104

Full Length Research Paper

Noninvasive ventilation in relapse of acute respiratory failure outside ICU

Killen Briones Claudett
  • Killen Briones Claudett
  • Pneumology and Intensive Care Unit Department, Military Hospital, Guayaquil – Ecuador.
  • Google Scholar
Mónica Briones Claudett
  • Mónica Briones Claudett
  • Pneumology and Intensive Care Unit Department, Military Hospital, Guayaquil – Ecuador.
  • Google Scholar
Miguel Chung Sang
  • Miguel Chung Sang
  • Pneumology and Intensive Care Unit Department, Military Hospital, Guayaquil – Ecuador.
  • Google Scholar
Hector Alajo Maiguashca
  • Hector Alajo Maiguashca
  • Pneumology and Intensive Care Unit Department, Military Hospital, Guayaquil – Ecuador.
  • Google Scholar
Diego Cruz Pico
  • Diego Cruz Pico
  • Medicine Faculty of the University San Francisco. Quito – Ecuador.
  • Google Scholar
Michel Grunauer Andrade
  • Michel Grunauer Andrade
  • Medicine Faculty of the University San Francisco. Quito – Ecuador.
  • Google Scholar
Antonio Esquinas Rodriguez
  • Antonio Esquinas Rodriguez
  • Intensive Care Unit and Pneumology Services, J. M. Morales Meseguer Hospital, Murcia - Spain.
  • Google Scholar
Gumersindo Gonzalez Diaz
  • Gumersindo Gonzalez Diaz
  • Intensive Care Unit and Pneumology Services, J. M. Morales Meseguer Hospital, Murcia - Spain.
  • Google Scholar


  •  Accepted: 29 October 2009
  •  Published: 31 March 2010

Abstract

The transfer of patients to the ICU from the General Ward could be a frequent issue of major concern in many hospitals around the world. We accessed the effectiveness of NIMV protocol outside ICU in sub-group of patients with relapse of acute respiratory failure and we also determined the factors associated with ICU transfer. This work is a prospective observational study. A total of 525 patients were treated of acute respiratory failure during this period of three years study. Of this, 353 (67.2%) were managed with standard therapy and 46 (8.7%) were presented with relapse and required NIMV outside ICU. The most frequent diagnoses were: COPD 22 (47.8%), CAP 13 (28.3%), CHF 5 (10.9%), asthma 4 (8.7), and diffuse interstitial pulmonary disease 2 (4.3%). Levels of IPAP were 13.5 ± 2.1 and EPAP 6.1 ± 0.8. Respiratory acidosis, the most recent finding, was (82.6%); transfer to the ICU, 5 (10.9%), and need for endotracheal intubation, 3 (6.5%).  2 (4.3%) patients in the study died and 44 (95.7%) patients were alive. The variables associated with transfer to the ICU were: IPAP level (p = 0.005), EPAP level (p = 0.03), antibiotic regimen changes (p = 0.01), and elevated HR (p = 0.04) and acid-base disorders (p = 0, 10). Cumulative survival at 13 months was 86% and in 36 months it was 73% by the Kaplan-Meier method. We identified a sub-group of patients who can benefit from the early application of NIMV protocoloutside ICU after the relapse of acute respiratory failure. However, a multi-centre study that involves a greater number of patients with these characteristic could be required.

 

Key words: Noninvasive mechanical ventilation, inspiratory positive airway pressure, emergency room, relapses, transfers UCI, failure.