{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:49:00Z","timestamp":1792568940945,"version":"4.5.0"},"reference-count":44,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T00:00:00Z","timestamp":1619481600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2021,7]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Acute respiratory failure is among the sequelae of complications that can develop in response to severe sepsis. Research into sepsis-related respiratory failure has focused on ARDS and invasive mechanical ventilation. We studied the factors associated with success and failure of noninvasive ventilation (NIV) in the treatment of sepsis-related acute respiratory failure.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n \n This retrospective study included 136 subjects with a diagnosis of acute respiratory failure and intrapulmonary or extrapulmonary sepsis who were placed on NIV. Subjects were divided into 2 groups based on the need for intubation from NIV: NIV failure (\n n<\/jats:italic>\n = 70) and NIV success (\n n<\/jats:italic>\n = 66). Demographic, clinical, and outcome data were collected and compared between groups, with the development of multivariate models to predict NIV failure and mortality.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n The overall NIV failure rate in subjects with a diagnosis of sepsis was 51%. There were no between-group differences in demographic or baseline characteristics. However, there were significant differences in clinical variables, with higher SOFA scores (NIV failure: 6.4 [\u00b1 3.0] vs NIV success: 4.9 [\u00b1 2.1];\n P<\/jats:italic>\n = .002), 2nd lactate levels (NIV failure: 2.6 [1.7 \u2013 4.3] vs NIV success: 1.9 [1.4 \u2013 2.6] mmol\/L;\n P<\/jats:italic>\n = .007), and initial NIV\n \n \n \n \n F<\/mml:mtext>\n \n \n \n IO<\/mml:mtext>\n <\/mml:mrow>\n 2<\/mml:mtext>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n settings (NIV failure: 0.50 [0.40 \u2013 0.70] vs NIV failure: 0.40 [0.35 \u2013 0.50];\n P<\/jats:italic>\n = .003) in subjects who failed NIV. There were also more subjects in the NIV failure group who had a lactate \u2265 4 mmol\/L prior to NIV start compared to those who succeeded on NIV (33% vs 15%,\n P<\/jats:italic>\n = .02). At NIV start, subjects in the NIV failure group had lower mean arterial pressure (85 mm Hg [IQR 74\u201396] vs 91.7 mm Hg [IQR 78\u2013108],\n P<\/jats:italic>\n = .042) and Glasgow coma scale scores (14 [IQR 13\u201315] vs 15 [IQR 14\u201315],\n P<\/jats:italic>\n < .002), while fewer subjects in the NIV failure group received a fluid bolus in the 24 h prior to NIV start (33% vs 53%,\n P<\/jats:italic>\n = .02) or had signs of volume overload (36% vs 64%,\n P<\/jats:italic>\n < .001). Multivariate analysis indicated that age (odds ratio 1.05 [95% CI 1.01\u20131.09],\n P<\/jats:italic>\n = .02), SOFA score (odds ratio 1.49 [95% CI 1.15\u20131.94],\n P<\/jats:italic>\n = .002), first systolic blood pressure (odds ratio 0.97 [95% CI 0.95\u20130.99],\n P<\/jats:italic>\n = .02), signs of volume overload (odds ratio 0.23 [95% CI 0.07\u20130.68],\n P<\/jats:italic>\n = .008], fluids prior to NIV (odds ratio 0.08 [95% CI 0.02\u20130.31],\n P<\/jats:italic>\n < .001), and initial\n \n \n \n \n F<\/mml:mtext>\n \n \n \n IO<\/mml:mtext>\n <\/mml:mrow>\n 2<\/mml:mtext>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n on NIV (odds ratio 1.04 [95% CI 1.01\u20131.08,\n P<\/jats:italic>\n = .002) independently predicted NIV failure with an area under the curve of 0.88. Only NIV failure independently predicted death in multivariate analysis (area under the curve = 0.70).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n \n NIV failure in sepsis-related acute respiratory failure was independently predicted by patient acuity, first systolic blood pressure after sepsis alert, initial\n \n \n \n \n F<\/mml:mtext>\n \n \n \n IO<\/mml:mtext>\n <\/mml:mrow>\n 2<\/mml:mtext>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n settings on NIV, fluid resuscitation, and signs of volume overload. However, only NIV failure independently predicted death in this cohort of subjects.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4187\/respcare.08599","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T14:38:02Z","timestamp":1619534282000},"page":"1063-1073","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Analysis of Noninvasive Ventilation in Subjects With Sepsis and Acute Respiratory Failure"],"prefix":"10.1177","volume":"66","author":[{"given":"Gail S","family":"Drescher","sequence":"first","affiliation":[{"name":"Pulmonary Services Department, MedStar Washington Hospital Center, Washington, DC. Ms Drescher is Technical Editor of R, espiratory C, are."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u2019moon M","family":"Al-Ahmad","sequence":"additional","affiliation":[{"name":"Pulmonary Services Department, MedStar Washington Hospital Center, Washington, DC. Ms Drescher is Technical Editor of R, espiratory C, are."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,4,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1208623"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.09.73"},{"key":"e_1_3_2_4_2","unstructured":"Centers for Medicare and Medicaid Services. CMS Measures Inventory Tool. Severe Sepsis and Septic Shock: Management Bundle. (Composite Measure). Available at: https:\/\/cmit.cms.gov\/CMIT_public\/ListMeasures. 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