• Jason Phua, Yvonne L E Ang, Kay Choong See, Amartya Mukhopadhyay, Erlinda A Santiago, Eleanor G Dela Pena, and Tow Keang Lim.
• Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, 119074, Singapore. phua_jason@yahoo.com.sg
• Intensive Care Med. 2010 Apr 1; 36 (4): 638-47.

PurposeTo describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure.MethodsRetrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV.ResultsAt baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO(2)/FiO(2) ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO(2)/FiO(2) ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease).ConclusionsThe hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients.

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