Is Noninvasive Positive Pressure Ventilation Effective In Patients With Acute Respiratory Distress Syndrome

Objective: The use of noninvasive positive pressure ventilation(NIPPV)in acute respiratory distress syndrome(ARDS)is debated.The aim of our study is to evaluate the efficacy and mortality of ARDS treated by NIPPV at respiratory intensive care unit(ICU)setting.Methods: This is a single-center prospective cohort study involving 141 consecutive subjects of ARDS treated with NIPPV via facial masks as the first-tool respiratory support between 1 January 2014 and 30 June 2013 in a respiratory ICU of a university medical center.These subjects met with included and excluded criterion.Patients were monitored clinically with clinical and arterial blood gas parameters,ventilatory support,ICU course,and outcome.The success of NIPPV was defined as no need for endotracheal intubation,while the failure of NIPPV as need for endotracheal intubation.Results: A total of 141 subjects were included in the study.The use of NIPPV was successful in 82(58.2%)subjects,while 59(41.8%)subjects required intubation.38(64.4%)deaths were encountered in NIPPV failure group while 4(4.9%)were in NIPPV success group.There was significant difference in in-hospital death between NIPPV failure and success groups(=56.354,P < 0.001).NIPPV failure was no higher in moderate and severe ARDS(=3.818,P=0.148);Complications occurred in 56(100%)subjects during the NIPPV process in NIPPV failure group,while no patients experienced complications in NIPPV success group.Complications occurrence during the NIPPV process was associated with high NIPPV failure rate(=141.000,P < 0.001).NIPPV failure and mortality were insignificantly higher in moderate and severe ARDS.Univariate analysis revealed high acute physiology and chronic health evaluation II(APACHE II)score(?21)at admission and SOFA score(?8)as predictors of NIPPV failure(two P<0.05).Logistic regression analysis showed APACHE II score(?21)combined with SOFA score(?8)had high predictive value on NIPPV failure(adjusted:OR=6.581,95%CI 1.962 to 22.070,P=0.002).Mortality at day 30 [38/59(64.4%)vs.4/82(4.9%),respectively for NIPPV failure and NIPPV success groups;P < 0.001]significantly differ.Conclusion :The effectiveness of NIPPV on ARDS depended on disease severity at admission of ICU and whether illness-self complications occurred under the NIPPV process,but independing of ARDS severity.NIPPV failure was associated with an increased risk of in-hospital death.