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Norrenberg M1, Grimaldi D1, Vandenabeele A1, Creteur J1
1Hopital Erasme, ICU, Brussels, Belgium
Background: NIV is a common technique used in intensive care units (ICU) to treat acute respiratory failure (ARF). Nevertheless, benefit of the technique differs in function of population.
NIV for Exacerbation of chronic obstructive pulmonary disease (COPD) prevenst intubation requirement and increases survival. The same benefit is observed for patients with cardiogenic pulmonary edema treated by continuous positive airway pressure (CPAP) or NIV. On the contrary, NIV for patients with de novo hypoxemic respiratory insufficiency doesn't present the same benefit. In this case NIV, by deleting intubation, could be deleterious.
HACOR scale, proposed by Jun Duan et al ICM 2016, includes very simple parameters obtained at bed side like heart rate, pH, Glasgow come sale GCS, PaO2/FiO2 and respiratory rate. A score >5 predicts a failure of NIV.
Purpose: The aim of the study was to calculate, retrospectively, in patients with ARF hospitalized in our ICU and treated by VNI or CPAP, the HACOR score at initiation of and 1 hour after VNI or CPAP and to look if the score could be associated with further intubation.
Methods: We analyzed, retrospectively, all patients hospitalized between January 1th 2016 and December 31th 2017, in ARF treated by NIV or CPAP. Exclusion criteria were "do not intubated" limitation, NIV intolerance, missing data. 336 patients with NIV were first selected and 326 patients treated with CPAP were selected with same exclusion criteria.
We used statistical logiciel (SPSS 25.0, IBM Corp., Armonk, NY) to compare our results to results presented by Jun Duan.
Results: From 336 patients treated with NIV, 51 were finally enrolled, 18 patients hypoxemic, and 33 hypoxemic and hypercapnic. From 326 patients treated with CPAP, 47 were finally enrolled.In hypoxemic patients on NIV, the HACOR score ≤ 5 adequately predicted NIV success or failure for 67% of patients at initiation of treatment and in only 50% after 1 hour. In COPD patients, it predicted adequately in 44% of cases at initiation and in 53% after 1 hour. Finally for hypoxemic patients on CPAP, it predicted adequately in 64% at initiation of CPAP and in 72% after 1 hour.
Intubation rate was respectively 33% in hypoxemic patients on NIV, 27% in COPD patients and 32% in hypoxemic patients on CPAP.
Conclusion(s): HACOR scale with a score ≤ 5, in our population of patients, seems to have a relatively lower predicted value to predict NIV success of failure. Better results were observed for hypoxemic patients after 1 hour of CPAP. For the other patients, target > 7 or 8 could have better prediction but it must be confirmed with a prospective study and higher number of patients.
Implications: Following our results and our practice, HACOR score ≤ 5, seems to be too low to predict NIV or CPAP failure. Other larger prospective studies must confirm or not our results.
Keywords: Non invasive ventilation, acute respiratory failure, ypoxemia
Funding acknowledgements: No funding.
NIV for Exacerbation of chronic obstructive pulmonary disease (COPD) prevenst intubation requirement and increases survival. The same benefit is observed for patients with cardiogenic pulmonary edema treated by continuous positive airway pressure (CPAP) or NIV. On the contrary, NIV for patients with de novo hypoxemic respiratory insufficiency doesn't present the same benefit. In this case NIV, by deleting intubation, could be deleterious.
HACOR scale, proposed by Jun Duan et al ICM 2016, includes very simple parameters obtained at bed side like heart rate, pH, Glasgow come sale GCS, PaO2/FiO2 and respiratory rate. A score >5 predicts a failure of NIV.
Purpose: The aim of the study was to calculate, retrospectively, in patients with ARF hospitalized in our ICU and treated by VNI or CPAP, the HACOR score at initiation of and 1 hour after VNI or CPAP and to look if the score could be associated with further intubation.
Methods: We analyzed, retrospectively, all patients hospitalized between January 1th 2016 and December 31th 2017, in ARF treated by NIV or CPAP. Exclusion criteria were "do not intubated" limitation, NIV intolerance, missing data. 336 patients with NIV were first selected and 326 patients treated with CPAP were selected with same exclusion criteria.
We used statistical logiciel (SPSS 25.0, IBM Corp., Armonk, NY) to compare our results to results presented by Jun Duan.
Results: From 336 patients treated with NIV, 51 were finally enrolled, 18 patients hypoxemic, and 33 hypoxemic and hypercapnic. From 326 patients treated with CPAP, 47 were finally enrolled.In hypoxemic patients on NIV, the HACOR score ≤ 5 adequately predicted NIV success or failure for 67% of patients at initiation of treatment and in only 50% after 1 hour. In COPD patients, it predicted adequately in 44% of cases at initiation and in 53% after 1 hour. Finally for hypoxemic patients on CPAP, it predicted adequately in 64% at initiation of CPAP and in 72% after 1 hour.
Intubation rate was respectively 33% in hypoxemic patients on NIV, 27% in COPD patients and 32% in hypoxemic patients on CPAP.
Conclusion(s): HACOR scale with a score ≤ 5, in our population of patients, seems to have a relatively lower predicted value to predict NIV success of failure. Better results were observed for hypoxemic patients after 1 hour of CPAP. For the other patients, target > 7 or 8 could have better prediction but it must be confirmed with a prospective study and higher number of patients.
Implications: Following our results and our practice, HACOR score ≤ 5, seems to be too low to predict NIV or CPAP failure. Other larger prospective studies must confirm or not our results.
Keywords: Non invasive ventilation, acute respiratory failure, ypoxemia
Funding acknowledgements: No funding.
Topic: Critical care
Ethics approval required: Yes
Institution: hopital erasme
Ethics committee: comite ethique hopital erasme
Ethics number: P2018/316
All authors, affiliations and abstracts have been published as submitted.
