Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection

Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group, 2009-2015 H1N1 SEMICYUC Working Group investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

RESULTS: Of 1,898 subjects, 806 underwent NIV, and 56.8% of them failed. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, infiltrates in chest radiograph, and ICU mortality (38.4% vs 6.3%) were higher (P < .001) in the NIV failure than in the NIV success group. SOFA score was the variable most associated with NIV failure, and 2 cutoffs were determined. Subjects with SOFA ≥ 5 had a higher risk of NIV failure (odds ratio = 3.3, 95% CI 2.4-4.5). ICU mortality was higher in subjects with NIV failure (38.4%) compared with invasive mechanical ventilation subjects (31.3%, P = .018), and NIV failure was associated with increased ICU mortality (odds ratio = 11.4, 95% CI 6.5-20.1).

BACKGROUND: Despite wide use of noninvasive ventilation (NIV) in several clinical settings, the beneficial effects of NIV in patients with hypoxemic acute respiratory failure (ARF) due to influenza infection remain controversial. The aim of this study was to identify the profile of patients with risk factors for NIV failure using chi-square automatic interaction detection (CHAID) analysis and to determine whether NIV failure is associated with ICU mortality.

METHODS: This work was a secondary analysis from prospective and observational multi-center analysis in critically ill subjects admitted to the ICU with ARF due to influenza infection requiring mechanical ventilation. Three groups of subjects were compared: (1) subjects who received NIV immediately after ICU admission for ARF and then failed (NIV failure group); (2) subjects who received NIV immediately after ICU admission for ARF and then succeeded (NIV success group); and (3) subjects who received invasive mechanical ventilation immediately after ICU admission for ARF (invasive mechanical ventilation group). Profiles of subjects with risk factors for NIV failure were obtained using CHAID analysis.

CONCLUSIONS: An automatic and non-subjective algorithm based on CHAID decision-tree analysis can help to define the profile of patients with different risks of NIV failure, which might be a promising tool to assist in clinical decision making to avoid the possible complications associated with NIV failure.

Original languageEnglish (US)
Pages (from-to)1307-1315
Number of pages9
JournalRespiratory Care
Volume62
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Noninvasive Ventilation
Critical Illness
Human Influenza
Infection
Respiratory Insufficiency
Artificial Respiration
Organ Dysfunction Scores
Mortality
Odds Ratio
Decision Trees
APACHE
Decision Support Techniques

Keywords

  • CHAID analysis
  • influenza infection
  • noninvasive ventilation
  • prognosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group, & 2009-2015 H1N1 SEMICYUC Working Group investigators (2017). Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection. Respiratory Care, 62(10), 1307-1315. https://doi.org/10.4187/respcare.05481

Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection. / Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group; 2009-2015 H1N1 SEMICYUC Working Group investigators.

In: Respiratory Care, Vol. 62, No. 10, 01.10.2017, p. 1307-1315.

Research output: Contribution to journalArticle

Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group & 2009-2015 H1N1 SEMICYUC Working Group investigators 2017, 'Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection', Respiratory Care, vol. 62, no. 10, pp. 1307-1315. https://doi.org/10.4187/respcare.05481
Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group, 2009-2015 H1N1 SEMICYUC Working Group investigators. Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection. Respiratory Care. 2017 Oct 1;62(10):1307-1315. https://doi.org/10.4187/respcare.05481
Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group ; 2009-2015 H1N1 SEMICYUC Working Group investigators. / Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection. In: Respiratory Care. 2017 ; Vol. 62, No. 10. pp. 1307-1315.
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T1 - Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection

AU - Grupo Español de Trabajo Gripe A Grave (GETGAG)/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) Working Group

AU - 2009-2015 H1N1 SEMICYUC Working Group investigators

AU - Rodríguez, Alejandro

AU - Ferri, Cristina

AU - Martin-Loeches, Ignacio

AU - Díaz, Emili

AU - Masclans, Joan R.

AU - Gordo, Federico

AU - Sole-Violán, Jordi

AU - Bodí, María

AU - Avilés-Jurado, Francesc X.

AU - Trefler, Sandra

AU - Magret, Monica

AU - Moreno, Gerard

AU - Reyes, Luis F.

AU - Marin-Corral, Judith

AU - Yebenes, Juan C.

AU - Esteban, Andres

AU - Anzueto, Antonio R

AU - Aliberti, Stefano

AU - Restrepo, Marcos

PY - 2017/10/1

Y1 - 2017/10/1

N2 - RESULTS: Of 1,898 subjects, 806 underwent NIV, and 56.8% of them failed. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, infiltrates in chest radiograph, and ICU mortality (38.4% vs 6.3%) were higher (P < .001) in the NIV failure than in the NIV success group. SOFA score was the variable most associated with NIV failure, and 2 cutoffs were determined. Subjects with SOFA ≥ 5 had a higher risk of NIV failure (odds ratio = 3.3, 95% CI 2.4-4.5). ICU mortality was higher in subjects with NIV failure (38.4%) compared with invasive mechanical ventilation subjects (31.3%, P = .018), and NIV failure was associated with increased ICU mortality (odds ratio = 11.4, 95% CI 6.5-20.1).BACKGROUND: Despite wide use of noninvasive ventilation (NIV) in several clinical settings, the beneficial effects of NIV in patients with hypoxemic acute respiratory failure (ARF) due to influenza infection remain controversial. The aim of this study was to identify the profile of patients with risk factors for NIV failure using chi-square automatic interaction detection (CHAID) analysis and to determine whether NIV failure is associated with ICU mortality.METHODS: This work was a secondary analysis from prospective and observational multi-center analysis in critically ill subjects admitted to the ICU with ARF due to influenza infection requiring mechanical ventilation. Three groups of subjects were compared: (1) subjects who received NIV immediately after ICU admission for ARF and then failed (NIV failure group); (2) subjects who received NIV immediately after ICU admission for ARF and then succeeded (NIV success group); and (3) subjects who received invasive mechanical ventilation immediately after ICU admission for ARF (invasive mechanical ventilation group). Profiles of subjects with risk factors for NIV failure were obtained using CHAID analysis.CONCLUSIONS: An automatic and non-subjective algorithm based on CHAID decision-tree analysis can help to define the profile of patients with different risks of NIV failure, which might be a promising tool to assist in clinical decision making to avoid the possible complications associated with NIV failure.

AB - RESULTS: Of 1,898 subjects, 806 underwent NIV, and 56.8% of them failed. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, infiltrates in chest radiograph, and ICU mortality (38.4% vs 6.3%) were higher (P < .001) in the NIV failure than in the NIV success group. SOFA score was the variable most associated with NIV failure, and 2 cutoffs were determined. Subjects with SOFA ≥ 5 had a higher risk of NIV failure (odds ratio = 3.3, 95% CI 2.4-4.5). ICU mortality was higher in subjects with NIV failure (38.4%) compared with invasive mechanical ventilation subjects (31.3%, P = .018), and NIV failure was associated with increased ICU mortality (odds ratio = 11.4, 95% CI 6.5-20.1).BACKGROUND: Despite wide use of noninvasive ventilation (NIV) in several clinical settings, the beneficial effects of NIV in patients with hypoxemic acute respiratory failure (ARF) due to influenza infection remain controversial. The aim of this study was to identify the profile of patients with risk factors for NIV failure using chi-square automatic interaction detection (CHAID) analysis and to determine whether NIV failure is associated with ICU mortality.METHODS: This work was a secondary analysis from prospective and observational multi-center analysis in critically ill subjects admitted to the ICU with ARF due to influenza infection requiring mechanical ventilation. Three groups of subjects were compared: (1) subjects who received NIV immediately after ICU admission for ARF and then failed (NIV failure group); (2) subjects who received NIV immediately after ICU admission for ARF and then succeeded (NIV success group); and (3) subjects who received invasive mechanical ventilation immediately after ICU admission for ARF (invasive mechanical ventilation group). Profiles of subjects with risk factors for NIV failure were obtained using CHAID analysis.CONCLUSIONS: An automatic and non-subjective algorithm based on CHAID decision-tree analysis can help to define the profile of patients with different risks of NIV failure, which might be a promising tool to assist in clinical decision making to avoid the possible complications associated with NIV failure.

KW - CHAID analysis

KW - influenza infection

KW - noninvasive ventilation

KW - prognosis

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