DOI: 10.1111/nicc.70689 ISSN: 1362-1017

Nurse‐Performed Bedside Respiratory Mechanics for Early Prediction of Non‐Invasive Ventilation Failure: A Prospective Observational Study

Longfang Pan, Xiaoqing Zhong, Qianru Zhao, Linfu Bai, Mengyi Ma, Yiwei Min, Yueling Hong, Jun Duan
Show PDF Cite

ABSTRACT

Background

Non‐invasive ventilation (NIV) failure is associated with increased mortality, underscoring the need for early predictors to guide timely intervention.

Aim

To explore the predictive value of ICU nurse‐measured tidal‐breathing maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak inspiratory flow (PIF) and peak expiratory flow (PEF) for NIV failure.

Study Design

This prospective observational study enrolled patients receiving NIV as first‐line therapy in a Chinese ICU. ICU nurses measured tidal‐breathing MIP, MEP, PIF and PEF before NIV initiation. NIV failure was defined as the requirement of intubation.

Results

Among 102 enrolled patients, 17 (17%) experienced NIV failure. The failure group showed significantly higher respiratory parameters: MIP (16.5 ± 5.4 vs. 10.2 ± 3.7 cmH 2 O ), MEP (17.6 ± 7.1 vs. 11.0 ± 4.6 cmH 2 O ), PIF (59 ± 21 vs. 38 ± 14 L/Min) and PEF (57 ± 23 vs. 37 ± 15 L/Min) (All p  < 0.001). AUCs for predicting NIV failure were 0.83 (95% CI : 0.74–0.89) for MIP , 0.81 (95% CI : 0.72–0.88) for MEP , 0.79 (95% CI : 0.70–0.87) for PIF and 0.77 (95% CI : 0.68–0.85) for PEF . The adjusted odds ratio for NIV failure was 1.42 (95% CI : 1.10–1.82, p  < 0.001) per one‐unit increase in MIP , 1.30 (95% CI : 1.03–1.65, p  = 0.027) per one‐unit increase in MEP , 1.05 (95% CI : 0.99–1.11, p  = 0.076) per one‐unit increase in PIF and 1.03 (95% CI : 0.99–1.09, p  = 0.180) per one‐unit increase in PEF .

Conclusions

Nurse‐performed bedside tidal‐breathing MIP, MEP, PIF and PEF may predict NIV failure. Elevated baseline MIP and MEP may increase the risk of NIV failure in critically ill patients.

Relevance to Clinical Practice

Nurse‐conducted bedside tidal‐breathing MIP and MEP measurement at NIV initiation supports rapid risk stratification. Identifying patients with elevated parameters enables intensified monitoring, timely ventilator adjustment and early intubation preparation, avoiding delayed interventions and optimising patient outcomes.

More from our Archive