Background: Noninvasive, Positive Pressure Ventilation (NIPPV) has been correlated positively in decreasing the rate of endotracheal intubation, length of hospital stay and ICU stay, and mortality. However, as a specialty hospital that utilized NIPPV daily, no large local data has been published. This study aims to gather, analyze data, and identify the outcomes of NIPPV with Acute Respiratory Failure (ARF) in the year 2014 at the Philippine Heart Center.
Method: A retrospective cross-sectional study of patients aged ≥ 19 years old admitted at the Philippine Heart Center due to ARF from January 1st 2014 to December 31st 2014 who received and met the criteria for NIPPV were included. The MedTraK Systems was used in patient screening and selection. Demographic data, co-morbidities, physiologic and laboratory parameters were gathered. Quantitative variables were summarized and presented as mean and standard deviation, while qualitative variables were tabulated and presented as frequency and percent distribution. Predictors of success were determined and tested using Logistic regression analysis. The level of significance was set at 0.05.
Result: One hundred forty two (142) patients were included in the study. Success rate of NIPPV was high in Cardiogenic Pulmonary Edema (93.5%), followed by Acute Exacerbation of COPD (AECOPD) (77.5%), and Pneumonia (74.1%). Logistic Regression Analysis identified the variables associated with risk of NIPPV failure: heart rate of >109 bpm (Odds ratio 1.0; 95% CI; P <0.008), respiratory rate of >27 cpm (Odds ratio 1.0; 95% CI; P 0.241), axillary temperature of >36.80C (Odds ratio 1.6; 95% CI; P 0.181), serum creatinine of >0.17 mmol/L (Odds ratio 4.1; 95% CI; P 0.366), serum sodium of >138.3 mmol/L (Odds ratio 1.0; 95% CI; P 0.452), hematocrit >0.39 (Odds ratio 13617.8; 95% CI; P < 0.010), and Apache Score II > 18.9 (Odds ratio 1.1; 95% CI; P < 0.080). Post NIPPV pH of 7.3 (Odds ratio 1.9; 95% CI; P < 0.093) and PaCO2 of 61.2 mmHg (Odds ratio 1.0; 95% CI; P < 0.067) were correlated with NIPPV failure.
Pneumonia was significantly related with higher risk of NIPPV failure (Odds ratio 5.1; 95% CI; P < 0.001).
Conclusion: NIPPV reduces the rate of invasive ventilation with various etiology of ARF with highest rate of success in Cardiogenic Pulmonary Edema, while Pneumonia is related significantly to failure. Essentially, the proper patient selection and the clinician experience with NIPPV is still the most vital factor of overall success.