Abstract Non-invasive positive pressure ventilation (NIPPV) is used in managing acute respiratory failure, particularly among patients with chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema (CPE). However, its effectiveness varies on the underlying cause of respiratory failure, the patient’s physiologic reserve, and overall severity of illness. In low- to middle-income settings where ICU capacity and ventilator availability may be limited, proper selection of patients for NIPPV becomes especially important to avoid delays in intubation and prevent deterioration. In the Philippines, local data to guide these decisions are limited. This study examined clinical outcomes and predictors of NIPPV success among adults treated at Davao Medical School Foundation Hospital. We reviewed the medical records of 239 adult patients who were started on NIPPV between January 2020 and June 2025 in either the ICU or private ward rooms equipped for critical care. Data collected included demographics, comorbidities, APACHE II scores, arterial blood gas results, and ventilator settings. Primary outcomes were survival and avoidance of endotracheal intubation. Secondary outcomes included duration of NIPPV use, length of hospital and ICU stay, complication rates, and mortality at 7, 14, and 28 days. Group comparisons used ANOVA and chi-square tests, and multivariate logistic regression was performed to identify independent predictors of survival, adjusted for severity of illness. Among the 239 patients, 148 (61.9%) survived while 91 (38.1%) died. Predictors of better survival included younger age (OR 0.98, p = 0.023), higher BMI (OR 1.06, p = 0.020), preserved mental status measured by Glasgow Coma Scale (OR 0.51, p = 0.032), and absence of sedation use (OR 0.26, p 0.001). Compared with COPD, pneumonia (OR 0.35, p = 0.039), acute pulmonary edema (OR 0.32, p = 0.039), and neurologic causes of respiratory failure (OR 0.24, p = 0.029) were associated with lower survival rates. Mortality increased from 25.1% at day 7 to 38.1% at day 28, with the highest rates in neurologic and pneumonia cases. ARDS and pneumonia had the longest ICU and hospital stays. The most common complications were mask discomfort, gastric distention, and aspiration. NIPPV demonstrated the greatest benefit in COPD and asthma, with higher survival and shorter hospitalization. In contrast, pneumonia, ARDS, and neurologic respiratory failure were linked to poorer outcomes, underscoring the importance of close monitoring and early recognition of treatment failure. These findings support the use of APACHE II and bedside clinical indicators to guide patient selection and decision-making in resource-limited hospitals. This abstract is funded by: None
Zailon et al. (2026) studied this question.