Challenges in Non-Invasive Ventilation: Understanding the Causes of NIV Failure and Complications

Öz

Non-invasive ventilation (NIV) has been successfully used in the treatment of acute respiratory failure. The objective of this study was to evaluate complications arising from NIV and their impact on therapy failure, with a specific focus on identifying the most common NIV-related complication leading to NIV failure. A retrospective analysis was conducted on data from 99 patients (54 males, mean age 66 +/- 8 years) who were admitted to Internal Intensive Care Unit between January 1, 2015, and December 30, 2017. These patients received NIV due to acute respiratory failure and were monitored in the intensive care unit for more than 24 hours. The patients' demographic data, causes of acute respiratory failure, and NIV-related complications were obtained from the recorded data. Complications with NIV included discomfort, which developed in 21 patients (21%); air leakage observed in 18 patients (18%), skin erosion in 16 patients (16%), irritated and dry eyes in 9 patients (9%), skin ulcer in 5 patients (5%), abdominal tension in 3 patients (3%), claustrophobia in 2 patients (2%), and hypotension in 1 patient (1%). Univariate and multivariate analyses conducted to evaluate the factors associated with NIV failure showed that discomfort with NIV was the most common factor contributing to failure (p = 0.039). Discomfort as an NIV-related complication was identified as the main factor of failure. Choosing the right equipment, providing appropriate ventilatory support, and thorough monitoring are key to minimizing complications and maximizing the effectiveness of NIV therapy.

Anahtar Kelimeler

• Non-Invasive Ventilation
• Complications
• Discomfort
• Treatment Failure

Noninvaziv Ventilasyondaki Zorluklar: NIV Başarısızlığı ve Komplikasyonlarının Nedenleri Anlamak

Öz

Non-invaziv ventilasyon (NIV), akut solunum yetmezliğinin tedavisinde başarılı bir şekilde kullanılmaktadır. Bu çalışmanın amacı, NIV uygulamasına bağlı gelişen komplikasyonları ve bu komplikasyonların tedavi başarısızlığı üzerindeki etkilerini değerlendirmek olup, özellikle NIV başarısızlığına en sık neden olan komplikasyonu belirlemeye odaklanılmıştır. 1 Ocak 2015 ile 30 Aralık 2017 tarihleri arasında Dahili Yoğun Bakım Ünitesine kabul edilen 99 hastanın (54 erkek, ortalama yaş 66 +/- 8 yıl) verileri üzerine retrospektif bir analiz yapıldı. Bu hastalara, akut solunum yetmezliği nedeniyle NIV uygulandı ve 24 saati aşan süre boyunca yoğun bakım ünitesinde takip edildiler. Hastaların demografik verileri, akut solunum yetmezliği nedenleri ve NIV komplikasyonları kaydedilen verilerden elde edildi. NIV ile ilişkili komplikasyonlar arasında 21 hastada (%21) gelişen rahatsızlık, 18 hastada (%18) hava kaçağı, 16 hastada (%16) cilt erozyonu, 9 hastada (%9) gözlerde iritasyon ve kuruluk, 5 hastada (%5) cilt ülseri, 3 hastada (%3) abdominal gerginlik, 2 hastada (%2) klostrofobi ve 1 hastada (%1) hipotansiyon yer almaktaydı. NIV başarısızlığı ile ilişkili faktörleri değerlendirmek amacıyla yapılan univaryant ve multivaryant analizlerde, NIV kullanımına bağlı rahatsızlık, başarısızlığa en sık katkıda bulunan faktör olarak tespit edilmiştir (p = 0,039). Bu çalışmada, NIV ile ilişkili bir komplikasyon olarak rahatsızlık, başarısızlığın ana faktörü olarak belirlenmiştir. Doğru ekipmanın seçilmesi, uygun ventilatuvar desteğin sağlanması ve titiz izlem, komplikasyonların en aza indirilmesi ve NIV tedavisinin etkinliğinin artırılması için önemlidir.

Anahtar Kelimeler

• Non-İnvaziv Ventilasyon
• Komplikasyonlar
• Rahatsızlık
• Tedavi Başarısızlığı

Kaynakça

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