Nutritional Risk Screening 2002 as a Predictor of Outcome During General Ward-Based Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease with Respiratory Failure
Jinbo Cui, Qunfang Wan, Xiaoling Wu, Yihua Zeng, Li Jiang, Dongmei Ao, Feng Wang, Ting Chen, Yanli Li
Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
Med Sci Monit 2015; 21:2786-2793
Noninvasive ventilation (NIV) may reduce the need for intubation and mortality associated with chronic obstructive pulmonary disease (COPD) with type II respiratory failure. Early and simple predictors of NIV outcome could improve clinical management. This study aimed to assess whether nutritional risk screening 2002 (NRS2002) is a useful outcome predictor in COPD patients with type II respiratory failure treated by noninvasive positive pressure ventilation (NIPPV).
MATERIAL AND METHODS: This prospective observational study enrolled COPD patients with type II respiratory failure who accepted NIPPV. Patients were submitted to NRS2002 evaluation upon admission. Biochemical tests were performed the next day and blood gas analysis was carried out prior to NIPPV treatment and 4 hours thereafter. Patients were divided into NRS2002 score ≥3 and NRS2002 score <3 groups and NIV failure rates were compared between both groups.
RESULTS: Of the 233 patients, 71 (30.5%) were not successfully treated by NIPPV. The failure rate was significantly higher in the NRS2002 score ≥3 group (35.23%) in comparison with patients with NRS2002 score <3 (15.79%) (p<0.05). Multivariate analysis indicated that PaCO2 (OR 1.25, 95%CI 1.172–1.671, p<0.05) prior to NIPPV treatment and NRS2002 score ≥3 (OR 1.76, 95%CI 1.303–2.374, p<0.05) were independent predictive factors for NIPPV treatment failure.
CONCLUSIONS: NRS2002 score ≥3 and PaCO2 values at admission may predict unsuccessful NIPPV treatment of COPD patients with type II respiratory failure and help to adjust therapeutic strategies. NRS2002 is a noninvasive and simple method for predicting NIPPV treatment outcome.
Keywords: Aged, 80 and over, Intubation, Intratracheal, Noninvasive Ventilation - methods, Nutritional Status, Oxygen - blood, Positive-Pressure Respiration - methods, Predictive Value of Tests, Prospective Studies, Pulmonary Disease, Chronic Obstructive - therapy, Respiratory Insufficiency - therapy, Risk Factors