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Dose–response characteristics of noninvasive ventilation in acute respiratory failure

Craig Hukins, Michelle Murphy, Timothy Edwards
ERJ Open Research 2020 6: 00041-2019; DOI: 10.1183/23120541.00041-2019
Craig Hukins
Dept of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
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  • ORCID record for Craig Hukins
  • For correspondence: craig.hukins@health.qld.gov.au
Michelle Murphy
Dept of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
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Timothy Edwards
Dept of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
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  • FIGURE 1
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    FIGURE 1

    Survival stratified by type of respiratory failure and duration of mask-on time (noninvasive ventilation “dose”) in bands of <4, 4–8, 8–16, 16–24 and >24 h. a) All patients, b) hypercapnic respiratory failure patients and c) hypoxaemic respiratory failure patients.

  • FIGURE 2
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    FIGURE 2

    Survival stratified by type of respiratory failure and mask-on time thresholds of <2, <4, <8, <16, <24 and <48 h. a) All patients, b) hypercapnic respiratory failure patients and c) hypoxaemic respiratory failure patients.

  • FIGURE 3
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    FIGURE 3

    Survival stratified by threshold of mask-on time. a) >2 versus <2 h, b) >4 versus <4 h, c) >8 versus <8 h and d) >24 versus <24 h.

  • FIGURE 4
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    FIGURE 4

    Survival stratified by type of respiratory failure and mask-on proportion (mask-on time relative to total therapy duration) calculated as mask-on time/(mask-on time+mask-off time) representing noninvasive ventilation “intensity”. a) All patients, b) hypercapnic respiratory failure patients and c) hypoxaemic respiratory failure patients.

Tables

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  • TABLE 1

    Clinical characteristics of the study cohort

    All patientsHCRF patientsHRF patientsp-value
    Subjects65459460
    Age years64.3 (53.4–71.9)55.2 (41.5–68.5)64.9 (55.3–73.9)0.79
    Male:female (% male)363:291 (55)317:277 (53)46:14 (77)<0.001
    Diagnoses
     COPD375 (57)360 (61)15 (25)<0.001
     Asthma35 (5)34 (6)1 (2)0.30
     Pneumonia117 (18)88 (15)29 (48)<0.001
     LRTI22 (3)20 (3)2 (3)0.72
     Bronchiectasis27 (4)26 (4)1 (2)0.51
     Lung cancer25 (3)16 (3)9 (15)<0.001
     Interstitial lung disease15 (2)4 (<1)11 (18)<0.001
     Acute pulmonary oedema41 (6)35 (6)6 (10)0.33
     Sleep disordered breathing171 (26)158 (27)13 (22)0.50
     Obesity243 (37)231 (31)12 (20)0.006
     Motor neurone disease23 (4)21 (4)2 (3)0.77
    Admission gas exchange
     pH7.43 (7.29–7.40)7.34 (7.29–7.39)7.44 (7.39–7.47)<0.001
     PaCO2 mmHg62.1 (53.0–75.0)65.0 (55.0–76.0)38.0 (32.5–43.0)<0.001
     PaO2/FIO2220.0 (180.0–258.9)222.7 (185.7–261.9)147.2 (79.0–244.5)<0.001
    Mortality68 (10.4)47 (7.9)21 (35.0)<0.001
    Patients requiring ICU12 (2)5 (<1)7 (12)<0.001
    Subsequent mortality5 (42)1 (20)4 (57)0.30
    Usual WHO Functional Class
     I43 (7)32 (5)11 (18)
     II311 (48)284 (48)27 (45)<0.001
     III298 (46)188 (32)10 (17)
     IV98 (15)86 (15)12 (20)

    Data are presented as n, median (interquartile range) or n (%), unless otherwise stated. HCRF: hypercapnic respiratory failure; HRF: hypoxaemic respiratory failure; COPD: chronic obstructive pulmonary disease; LRTI: lower respiratory tract infection; PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction; ICU: intensive care unit; WHO: World Health Organization. p-values refer to differences between HCRF and HRF cohorts.

    • TABLE 2

      Noninvasive ventilation (NIV) characteristics and parameters

      All patientsHCRF patientsHRF patientsp-value
      Subjects65459460
      Duration of NIV therapy# days2.74 (1.51–4.73)2.76 (1.53–1.23)2.25 (1.23–5.95)0.56
      Total mask-on time¶ h34.0 (18.0–60.0)34.0 (18.2–60.0)34.0 (10.0–60.0)0.42
      Proportion of mask-on time %56.1 (41.2–69.5)55.2 (41.5–68.5)65.6 (33.7–85.2)0.07
      Settings
       Inspiratory pressure cmH2O18.0 (16.0–22.0)19.0 (16.0–22.0)15.0 (12.5–16.8)<0.001
       Expiratory pressure cmH2O10 (8–14)10 (8–14)8.5 (6.5–10.0)0.07
       Pressure support cmH2O8 (5–15)8 (5–15)6 (4–11)<0.001
      Out-of-protocol cessation of NIV+37 (6)29 (4)8 (13)0.02
       Intolerance of treatment20182
       Change to palliative treatment intent12750.10
       Treatment ineffective541

      Data are presented as n, median (interquartile range) or n (%), unless otherwise stated. HCRF: hypercapnic respiratory failure; HRF: hypoxaemic respiratory failure. #: overall period where NIV was used (including mask-on and mask-off durations); ¶: cumulative period where the therapy was actually in use; +: therapy was stopped before clinical stability was achieved. p-values refer to differences between HCRF and HRF cohorts.

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      Dose–response characteristics of noninvasive ventilation in acute respiratory failure
      Craig Hukins, Michelle Murphy, Timothy Edwards
      ERJ Open Research Jan 2020, 6 (1) 00041-2019; DOI: 10.1183/23120541.00041-2019

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      Dose–response characteristics of noninvasive ventilation in acute respiratory failure
      Craig Hukins, Michelle Murphy, Timothy Edwards
      ERJ Open Research Jan 2020, 6 (1) 00041-2019; DOI: 10.1183/23120541.00041-2019
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