• Francesca Moretto, Martina Fracazzini, Federico Verdina, Daniela Ferrante, Sara Baino, Francesca Grossi, Luigi Castello, Gianmaria Cammarota, Piero Balbo, Pier Paolo Sainaghi, Mauro Campanini, Mario Pirisi, Giuseppe Patti, MolinAlberto DalADDipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy.Anestesia e Terapia Intensiva, Azienda Ospedaliero Universitaria "Maggiore della Carità," Novara, Italy., Francesco Della Corte, Paolo Navalesi, and Rosanna Vaschetto.
• Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy.
• Respir Care. 2022 Jul 19.

BackgroundNoninvasive respiratory support (NRS) has been used to treat acute respiratory failure outside the ICU, but existing data have left many knowledge gaps for managing NRS in general wards. The primary objective of this study was to describe indications, duration of treatment, and outcomes of subjects treated with NRS outside the ICU. The secondary objective was to compare outcomes based on age < 80 or ≥ 80 y.MethodsThis retrospective observational study was conducted at Maggiore della Carità University Hospital in Novara, Italy, and included all patients treated with noninvasive ventilation (NIV) or CPAP outside the ICU from November 2017 to October 2018, with 1 year of follow-up.ResultsOf the 570 treatments performed, 383 subjects were analyzed, 136 NIV and 247 CPAP. Subjects' median (interquartile range [IQR]) age was 79 (72-85) y, and the main diagnoses of respiratory failure were cardiogenic pulmonary edema in 128 subjects (33%), pneumonia in 99 (26%), and COPD exacerbation in 52 (14%), with a median (IQR) treatment duration of 38 (16-74) h. Rapid response team visits lasted a median (IQR) 3 (2-6) d. Interface-related pressure lesions occurred in 13% of the subjects, in no case leading to definitive treatment discontinuation. Compared with the subjects ≥ 80 y old, the younger subjects had a median (IQR) longer hospitalization (16 [10-24] d vs 13 [9-20] d; P = .003) but slightly decreased in-hospital mortality (21% vs 30%; P = .061) and a decreased post-discharged 1-year mortality in hospital survivors (25% vs 41%; P = .002), differences observed only in the subjects treated with NIV.ConclusionsIn a real-life setting outside the ICU, NIV and CPAP managed by a rapid response team with a daily visit in collaboration with ward staff highly experienced in NRS allowed us to treat the subjects without major complications. Post-discharge 1-year mortality was higher in the subjects ≥ 80 y old treated with NIV for acute hypercapnic respiratory failure.Copyright © 2022 by Daedalus Enterprises.

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