Non-Invasive Ventilation: Experience at an Internal Medicine Service

Abstract

Introduction: Non-invasive ventilation (NIV) is a non-intrusive
form of ventilatory support, with proven benefits in several
clinical conditions. The objective was to assess NIV indications in patients with respiratory insufficiency and to identify
predictors of NIV response.
Material and Methods: Retrospective analysis of the clinical
processes of patients undergoing NIV, admitted to Internal
Medicine, between January and December 2014.
Results: Study included 54 patients, with a mean age of
82.2 years (± 8.4). Forty-four patients had pathologies that
are considered indications, with established evidence of the
need of NIV: 33 (75.0%) had heart failure, five (11.4%) acute
exacerbation of chronic obstructive pulmonary disease, four
(9.1%) obesity hypoventilation syndrome and two (4.5%) severe immunocompromised pneumonia. The failure rate was
20.5%. In the remaining 10 patients, NIV was used in severe
immunocompetent pneumonia, septic shock and benzodiazepine intoxication, with a failure rate of 70.0%. There was
a statistically significant improvement in gasometer parameters two hours after NIV in patients demonstrating clear evidence for the need of NIV and in patients in whom there was
no failure of this ventilatory modality.
Conclusion: In our sample the failure rate of NIV was significantly lower in patients who complied with the formal indications for the initiation of this type of ventilation. Thus, despite
the increasing use of NIV, careful patient selection is an essential step in its success. The best predictor of NIV success
was good response after 1 to 2 hours of therapy