PT  - JOURNAL ARTICLE
AU  - Craig Hukins
AU  - Michelle Murphy
AU  - Timothy Edwards
TI  - Dose–response characteristics of noninvasive ventilation in acute respiratory failure
AID  - 10.1183/23120541.00041-2019
DP  - 2020 Jan 01
TA  - ERJ Open Research
PG  - 00041-2019
VI  - 6
IP  - 1
4099  - http://openres.ersjournals.com/content/6/1/00041-2019.short
4100  - http://openres.ersjournals.com/content/6/1/00041-2019.full
SO  - erjor2020 Jan 01; 6
AB  - Acute noninvasive ventilation (NIV) is a well-established therapy for acute respiratory failure but the dose–response characteristics of this therapy have not been defined. The aim of this study was to define this dose–response relationship.This study was a retrospective review of patients receiving NIV for acute respiratory failure in a tertiary hospital respiratory high-dependency unit between July 2012 and June 2017. Mask-on time (rather than the period that NIV was in use) as the “dose” was compared with hospital survival as the “response”.654 patients were included, 594 (91%) with hypercapnic respiratory failure (HCRF). NIV was used for a median (interquartile range (IQR)) duration of 2.74 (1.51–4.73) days and median (IQR) mask-on time was 34 (18–60) h (56.1% (41.2–69.5%) of treatment time). There was evidence of a dose–response relationship in the HCRF group up to a ceiling of 24 h mask-on time, but not in the hypoxaemic respiratory failure (HRF) group. There was a difference in survival with as little as 2 h mask-on time (92% compared with 73%; p<0.001). Patients requiring NIV for 80–100% of therapy time had lower survival.We conclude that there is evidence of a dose–response relationship between cumulative NIV usage (mask-on time) and survival from as little as 2 h to a ceiling of ∼24 h in HCRF, but not in HRF.Acute NIV in respiratory failure has a dose–response effect on survival from as little as 2 h of therapy http://bit.ly/2okErQZ