Ventilación no invasiva en la insuficiencia respiratoria aguda en un área de alta dependencia de urgencias: Result dos asistenciales y pronóstico a medio plazo

Aim: To analyse the results of the patients treated with non-invasive ventilation (NIV) in an Intermediate Care Unit (IMCU) of the Emergency department (ED), as well as their course in the follow-up after one year. Material and Method: A single-centre, observational, analytical-prospective, 1-year follow-up study of a cohort of 112 patients treated with NIV. The following variables were collected: Epidemiological, clinical and analytical data, respiratory method, hospital stay and destination when discharged from the unit. Survivors of the initial hospitalization were followed with the record or readmissions and deaths. Results: 112 patients, with a mean age of 76 years, homogeneous for gender, with an APACHE II score of 16 and a Charlson index of 3, were ventilated; 75.9% of these patients came from ED. The cause of acute respiratory failure (ARF) was acute pulmonary oedema (APO) in 44.9%, COPD flare up 24.5%, and pneumonia in 16.9%. Four point five percent (4.5%) died in the IMCU, and 4.5% required tracheal intubation and were admitted to intensive care unit (ICU). Thirty-one point five percent (31.5%) were sent to a respiratory support unit, and the rest were sent to a conventional ward. After discharge from the hospital: 79 patients (70.5%), 54 (68.3%) needed to be readmitted and 51 (52.6%) were alive after one year. The independent factors associated to mortality were: Referral from a ward, refusal of admission into ICU, and extended stay at the IMCU; none were due to readmission. Conclusions: NIV is effective and applicable in ED by trained internists with an adequate monitoring. Referral from a ward, refusal of admission by ICU and the extended stay at the unit are associated to a worse life prognosis.