Noninvasive ventilation for acute respiratory failure after lung resection: an observational study

Byline: Aurelie Lefebvre (1), Christine Lorut (1), Marco Alifano (2), Herve Dermine (3), Nicolas Roche (1), Remy Gauzit (3), Jean-Francois Regnard (2), Gerard Huchon (1), Antoine Rabbat (1,4) Keywords: Noninvasive ventilation; Acute respiratory failure; Postoperative thoracic surgery; Lung resection; COPD; Outcomes Abstract: Background A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome. Method We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation. Results Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P < 0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5 95% confidence interval, 1.9--68.3 P = 0.007) and no initial response to NIV (odds ratio, 117.6 95% confidence interval, 10.6--1305.8 P = 0.0001). Conclusion This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection. Author Affiliation: (1) Department of Respiratory and Intensive Care Medicine, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (2) Department of Thoracic Surgery, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (3) Department of Anesthesiology and Surgical Intensive Care, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (4) Pneumologie et Reanimation, Hotel-Dieu, 1, place du parvis de Notre-Dame, 75181, Paris Cedex 04, France Article History: Registration Date: 01/10/2008 Received Date: 08/04/2008 Accepted Date: 26/09/2008 Online Date: 14/10/2008 Article note: This work was presented during the September 2008 ESICM congress in Lisbon international meeting and published as an abstract. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1317-z) contains supplementary material, which is available to authorized users.