Noinvasive ventilation in relapse of acute respiratory failure outside ICU

The transfer of patients to the ICU from General Ward could be a frequent issue of major concern in many hospitals around the world. We assed the effectiveness of NIMV protocol outside ICU in sub-group of patients with relapse of acute respiratory failure and determine the factors associated with ICU transfer.Methods: Prospective observational study. A total of 525 patients were treated of acute respiratory failure during this period of three years study. (Of this 353 (67.2%) were managed with standard therapy and 46 (8.7%), presented with relapse and required. NIMV outside ICU.Results:. The most frequent diagnoses were: COPD 22 (47.8%), CAP 13 (28.3%), CHF 5 (10.9%), Asthma 4 (8.7), Diffuse Interstitial Pulmonary Disease 2 (4.3%). Levels of IPAP were 13.5 ± 2.1 and EPAP 6.1 ± 0.8. Respiratory acidosis was the more frequent finding (82.6%).Transfer to the ICU 5 (10.9%), need for endotracheal intubation 3 (6.5%). 2 (4.3%) patients in the study died, and 44 (95.7%) patients alive.The variables associated with transfer to the ICU were: IPAP level (p=0.005), EPAP level (p=0.03), Antibiotic Regimen Changes (p=0.01), and elevated HR (p=0.04) and acid-base disorders (p=0, 10). Cumulative survival at 13 months was 86% and in 36 months it was 73% by the Kaplan-Meier method Conclusions: We identified a sub-group of patients who can benefit from the early application of NIMV protocol outside ICU after the relapse of acute respiratory failure However, a multi-centre study, that involves a greater number of patients with these characteristic could be required.