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Table 2 The risk factors and suggestions for the management of NIV failure based on timing

From: Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies

Time Risk factors Suggested interventions References
Immediate 1. Weak cough reflex and/or excessive secretions 1a. Manual or mechanic chest physiotherapeutic techniques; b. Early fiberoptic bronchoscopy. [1424]
2. Hypercapnic encephalopathy and coma 2a. Set a back-up rate ~ 15 b/min and/or use PCV; b. Decrease the FİO2 level. [16, 2527]
3. Intolerance and psychomotor agitation 3. Judicious sedation [14, 2832]
4. “Fighting with the machine”: Patient-ventilator asynchrony 4a. Closely monitor ventilator waveforms; b. Judicious sedation; c. Use a ventilator with an NIV platform; d. Change ventilatory parameters; e. Minimize air-leaks. [33, 34]
Early Hypoxemic ARF 1. Baseline ABG and inability to correct gas exchange (P/F < 150)*   [4] ([36, 38, 39, 42]*])
2. Baseline severity scores (SAPS II >35)*   [1, 5, 36]*,[37]*,[39, 43, 49]*-[51]
3. The presence of ARDS/pneumonia/sepsis/multiorgan failure (OR: 4-28)*   [36]*,[40, 41, 49, 50, 52]*-[54]
4. Increased respiratory rate (>25 breaths/min)*   [51]*,[53, 55]*,[56]
5. Miscellaneous: Delay between admission and NIV use, Number of fiberoptic bronchoscopes performed, Duration of NIV use, Increase in radiographic infiltrates within the first 24 hours, Causal diagnosis (as ‘de novo’)   [1, 36, 43, 51, 53, 57]
Hypercapnic ARF 1. Baseline ABG and inability to correct gas exchange (pH < 7.25)*   [3]*,[6, 12, 14, 5860, 62, 63]
2. Increased severity of disease   [3, 12, 14, 15, 59, 62, 64]
3. Increased respiratory rate (>35 breaths/min, OR for baseline and after 2 hours of NIV: 2.66 and 4.95)*   [3]*,[6, 15, 58, 59]
4. Mixed indices:   
 GCS, APACHE II score, respiratory rate and pH   [3]
 Respiratory rate, random glucose level and APACHE II   [66]
 Anemia and World Health Organization Performance Status (WHO-PS)   [67]
5. Miscellaneous: Poor nutritional status, Increased heart rate, Higher baseline C-reactive protein/white blood cell count, Lower serum potassium, Airway colonization by non-fermenting gram-negative bacilli   [63, 68, 69]
Late 1. Sleep disturbance 1a. Improve quality of sleep; b. Avoid excessive noise and light in the unit [70]
2. Functional limitation   [2]
3. Possible initial improvement in pH 3a. Close and continuous monitoring of vital parameters; b. Repeat frequent ABGs during NIV, even when gas exchange reach a satisfactory value [2, 64]
4. Hyperglycemia   
4. Check glucose levels [2]
  1. Odd Ratio (OR) or absolute “predictive” values for some parameters are reported from the studies quoted in the references and marked with * from other references.