000			04681nam a22005537a 4500
008			210607s20212021 xxu||||| |||| 00| 0 eng d
022			_a0020-1324
024			_a10.4187/respcare.08599 [doi]
024			_arespcare.08599 [pii]
040			_aOvid MEDLINE(R)
099			_a33906956
245			_aAnalysis of Noninvasive Ventilation in Subjects With Sepsis and Acute Respiratory Failure.
251			_aRespiratory Care. 66(7):1063-1073, 2021 Jul.
252			_aRespir Care. 66(7):1063-1073, 2021 Jul.
252			_zRespir Care. 2021 Apr 27
253			_aRespiratory care
260			_c2021
260			_fFY2022
265			_saheadofprint
265			_sppublish
266			_d2021-06-07
268			_aRespiratory Care. 2021 Apr 27
269			_fFY2021
520			_aBACKGROUND: Acute respiratory failure is among the sequelae of complications that can develop in response to severe sepsis. Research into sepsis-related respiratory failure has focused on ARDS and invasive mechanical ventilation. We studied the factors associated with success and failure of noninvasive ventilation (NIV) in the treatment of sepsis-related acute respiratory failure.
520			_aCONCLUSIONS: NIV failure in sepsis-related acute respiratory failure was independently predicted by patient acuity, first systolic blood pressure after sepsis alert, initial FIO2 settings on NIV, fluid resuscitation, and signs of volume overload. However, only NIV failure independently predicted death in this cohort of subjects. Copyright (c) 2021 by Daedalus Enterprises.
520			_aMETHODS: This retrospective study included 136 subjects with a diagnosis of acute respiratory failure and intrapulmonary or extrapulmonary sepsis who were placed on NIV. Subjects were divided into 2 groups based on the need for intubation from NIV: NIV failure (n = 70) and NIV success (n = 66). Demographic, clinical, and outcome data were collected and compared between groups, with the development of multivariate models to predict NIV failure and mortality.
520			_aRESULTS: The overall NIV failure rate in subjects with a diagnosis of sepsis was 51%. There were no between-group differences in demographic or baseline characteristics. However, there were significant differences in clinical variables, with higher SOFA scores (NIV failure: 6.4 [+/- 3.0] vs NIV success: 4.9 [+/- 2.1]; P = .002), 2nd lactate levels (NIV failure: 2.6 [1.7 - 4.3] vs NIV success: 1.9 [1.4 - 2.6] mmol/L; P = .007), and initial NIV FIO2 settings (NIV failure: 0.50 [0.40 - 0.70] vs NIV failure: 0.40 [0.35 - 0.50]; P = .003) in subjects who failed NIV. There were also more subjects in the NIV failure group who had a lactate >= 4 mmol/L prior to NIV start compared to those who succeeded on NIV (33% vs 15%, P = .02). At NIV start, subjects in the NIV failure group had lower mean arterial pressure (85 mm Hg [IQR 74-96] vs 91.7 mm Hg [IQR 78-108], P = .042) and Glasgow coma scale scores (14 [IQR 13-15] vs 15 [IQR 14-15], P < .002), while fewer subjects in the NIV failure group received a fluid bolus in the 24 h prior to NIV start (33% vs 53%, P = .02) or had signs of volume overload (36% vs 64%, P < .001). Multivariate analysis indicated that age (odds ratio 1.05 [95% CI 1.01-1.09], P = .02), SOFA score (odds ratio 1.49 [95% CI 1.15-1.94], P = .002), first systolic blood pressure (odds ratio 0.97 [95% CI 0.95-0.99], P = .02), signs of volume overload (odds ratio 0.23 [95% CI 0.07-0.68], P = .008], fluids prior to NIV (odds ratio 0.08 [95% CI 0.02-0.31], P < .001), and initial FIO2 on NIV (odds ratio 1.04 [95% CI 1.01-1.08, P = .002) independently predicted NIV failure with an area under the curve of 0.88. Only NIV failure independently predicted death in multivariate analysis (area under the curve = 0.70).
546			_aEnglish
650			_a*Noninvasive Ventilation
650			_a*Respiratory Distress Syndrome
650			_a*Respiratory Insufficiency
650			_a*Sepsis
650			_aHumans
650			_aRespiratory Distress Syndrome/th [Therapy]
650			_aRespiratory Insufficiency/et [Etiology]
650			_aRespiratory Insufficiency/th [Therapy]
650			_aRetrospective Studies
650			_aSepsis/co [Complications]
650			_aSepsis/th [Therapy]
651			_aMedStar Washington Hospital Center
656			_aInternal Medicine Residency
656			_aRespiratory Therapy
657			_aJournal Article
700			_aAl-Ahmad, Ma'moon
700			_aDrescher, Gail S
790			_aAl-Ahmad MM, Drescher GS
856			_uhttps://dx.doi.org/10.4187/respcare.08599 _zhttps://dx.doi.org/10.4187/respcare.08599
942			_cART _dArticle
999			_c6272 _d6272