Ventilation non invasive dans l’insuffisance respiratoire aiguë en service de pneumologie

Introduction. Noninvasive ventilation (NIV) is considered as the first choice treatment for selected patients with acute respiratory failure (ARE), but many hospitals are forced to start NIV on medical wards. Methods. The aim of this retrospective study was to assess the outcomes of NIV initiated for ARE on a respiratory ward and to find the criteria predictive of failure. All patients were treated in a four-bed ward specifically dedicated to NIV. Failure of NIV was defined as the need for intubation and transfer to ICU, or death. Results. Among 105 admissions with ARF, 49 episodes needed NIV. These episodes were divided into 2 groups: PaCO2 < 45 mmHg (10) and PaCO2 > 45 mmHg (39). The overall failure rate of NIV and overall in-hospital mortality rate were 26.5% and 17% respectively. On multivariate analysis, SAPS II and respiratory acidosis with a pH less than 7.30 were significantly associated with failure of NIV. Conclusions. NIV is practicable and is effective in the management of mild to moderate ARE on a respiratory ward. However, patients with respiratory acidosis and a pH less than 7.30 are at risk of NIV failure. (C) 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.