Incidence, predictors, and outcomes of failure of noninvasive ventilation in acute heart failure hospitalization

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Abstract

BACKGROUND: Some patients with acute heart failure (AHF) who are treated initially with nonin-vasive ventilation (NIV) will require endotracheal intubation, which indicates NIV failure. The incidence and prognosis of NIV failure in patients with AHF are not well characterized. METHODS: Using the National In-Patient Sample (NIS), we conducted a retrospective cohort study of subjects hospitalized with AHF between 2008 and 2014 who were treated with NIV within 24 h of hospital admis-sion. We determined predictors of NIV failure and determined the association between NIV failure and in-hospital mortality using Cox proportional hazard models. RESULTS: Of 279,534 subjects hospitalized with AHF and treated with NIV, 4,257 (1.52%) failed NIV and required intubation. Cardiogenic shock (odds ratio 8.79, 95% CI 6.89–11.2) and in-hospital arrest (odds ratio 24.9, 95% CI 18.71–33.14) were associated with NIV failure. In-hospital mortality was 26.5% for NIV failure com-pared to 5.6% for those without NIV (P < .001). After adjustment for demographics, comorbidities, cardiogenic shock, and in-hospital arrest, NIV failure was associated with nearly a 2-fold risk of in-hospital mortality (odds ratio 1.95, 95% CI 1.59–2.40). CONCLUSIONS: Intubation after initial NIV treatment was required in 1.5% of subjects hospitalized with AHF and treated with NIV, and was associated with high in-hospital mortality. These findings can guide future prospective interventional Key words trials and quality improvement ventures.

Original languageEnglish (US)
Pages (from-to)1527-1533
Number of pages7
JournalRespiratory care
Volume65
Issue number10
DOIs
StatePublished - Oct 1 2020

Keywords

  • Acute heart failure
  • Intubation
  • Noninva-sive ventilation
  • Respiratory failure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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