[Predictive factors of non-invasive ventilation failure in patients with severe acute exacerbation of chronic obs-tructive pulmonary disease. Multicenter study].

Abstract

BACKGROUND: Non invasive ventilation (NIV) has become an integral tool to assist patients with severe chronic obstructive pulmonary disease (COPD) exacerbation. However, the success of NIV in these patients remains relatively random and predictors of response are poorly known. AIM: To study the predictors of NIV failure in patients hospitalized for severe COPD exacerbation. METHODS: Comparative and retrospective study including patients hospitalized for severe COPD exacerbation and who received NIV. Our work studied the predictive factors of NIV failure. Failure of NIV is defined by transfer to intensive care unit (ICU) with use of invasive ventilation. RESULTS: Among the 268 patients hospitalized in the pulmonology department during the study period for COPD exacerbation, 68 (25.4 %) required the use of NIV. The average age was 60.8 ± 9.6 years. Sex ratio was 8.6. In multivariate analysis, cyanosis [Odds Ratio (OR) : 31.5; 95 % Confidence Interval (CI) : 4.5-221.9], heart rate ≥ 110 beats/min (OR : 10.1, 95 % CI : 1.9-52.9), signs of respiratory encephalopathy (OR : 6.6, 95 % CI : 1.4-32.1) and poor tolerance to NIV (OR : 5.9 % CI : 1.1-25.8) were associated with the ICU transfer. CONCLUSION: Presence at admission of cyanosis, tachycardia, signs of respiratory encephalopathy and poor tolerance to NIV are predictive factors for NIV failure in patients with severe COPD exacerbation.