Noninvasive Ventilation on Acute Hypoxemic Respiratory Failure: Analysis of Therapeutic Impact in an Observational study

Background. Patients with acute hypoxemic respiratory failure (AHRF) represent a heterogeneous group of conditions, often associated with pneumonia and characterized by varied etiopathogenesis. Pathophysiologically, pulmonary involvement may be alveolar, interstitial, or alveolointerstitial. Oxygen therapy is the first-line treatment. The lack of clinical improvement with high-concentration oxygen therapy and the absence of immediate intubation criteria suggest the potential benefit of non-invasive ventilation (NIV). Objective. The aim of this study was to assess the impact of NIV on intubation and mortality in patients admitted to the ICU for AHRF of various etiologies and to identify predictive factors associated with NIV failure. Methods. This is an observational cohort study using data collected prospectively over a one-year period in the medical intensive care unit of Sétif University Hospital. Results. Among 35 patients treated with NIV for AHRF, 23 were not intubated. NIV significantly reduced the respiratory rate from 41.85 ± 7.91 cycles/min at admission to 29.06 ± 7.29 cycles/min (p = 0.001), without improving the PaO₂/FiO₂ ratio (p = 0.69). The effectiveness of NIV varied according to the etiology of AHRF and the severity of hypoxemia. Interstitial lung disease was significantly associated with NIV failure (OR: 7.39; 95% CI [1.44–37.9], p = 0.01). A PaO₂/FiO₂ ratio < 150 mmHg was an independent risk factor for failure (OR: 5.2; 95% CI [1.02– 27.75], p = 0.04). Patients requiring intubation had a very high ICU mortality rate. Conclusion. The impact of NIV on preventing intubation was 65.7% across all cases of AHRF. NIV may serve as first-line ventilatory support when the PaO₂/FiO₂ ratio is > 150 mmHg. Conversely, 75% of patients with a PaO₂/FiO₂ ratio < 150 mmHg required intubation, resulting in increased mortality.