Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure
Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure
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DOI：
10.1097/ccm.0b013e3181bc8243
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发表时间：
2010-02-01
影响因子：
8.8
通讯作者：
Brochard, Laurent
中科院分区：
文献类型：
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作者：
Campo, Ferran Roche;Drouot, Xavier;Brochard, Laurent
目的：确定睡眠质量是否有助于预测急性高碳酸血症呼吸衰竭患者的无创通气结局。尽管初步临床有所改善，但近四分之一的患者可能会在几天后无法进行无创通气。由于晚期插管与不良预后相关，因此确定可预测或解释晚期无创通气失败的因素可能会有所帮助。患者：我们前瞻性研究了医疗重症监护病房中需要无创通气 >48 小时的 27 名高碳酸血症患者。干预措施：在无创通气开始后 2 天至 4 天记录 17 小时睡眠多导睡眠图（下午 3 点至上午 8 点）。晚期无创通气失败定义为死亡、气管插管或第 6 天持续需要无创通气。 测量和主要结果：14 名晚期无创通气失败患者中有 7 名 (50%) 发现异常脑电图模式，无法通过标准睡眠评分标准进行分析，而成功接受无创通气治疗的 13 名患者中有 1 名 (8%) (P = .03)。没有临床或实验室变量可以解释脑电图差异。与无创通气成功治疗的患者相比，无创通气失败的患者睡眠质量较差，昼夜节律睡眠周期中断较多，夜间快速眼动睡眠较少（6 分钟[范围，0-12] vs. 26 分钟[范围，6-49]，p = .03）。无创通气失败与重症监护病房住院期间的谵妄相关（64% vs. 0%）。结论：急性高碳酸血症性呼吸衰竭老年患者的晚期无创通气失败与早期睡眠障碍相关，包括脑电图模式异常、昼夜节律睡眠周期中断和快速动眼睡眠减少。 （《重症监护医学》2010 年；38：477-485）
Objective: To determine whether sleep quality helps to predict noninvasive ventilation outcome in patients with acute hypercapnic respiratory failure. Despite an initial clinical improvement, nearly one fourth of patients may fail noninvasive ventilation after several days. Because late intubation is associated with a poor prognosis, it may be useful to identify factors that may predict or explain late noninvasive ventilation failure.Patients: We prospectively studied 27 hypercapnic patients in a medical intensive care unit who required noninvasive ventilation for >48 hrs.Interventions: A 17-hr sleep polysomnography (3 PM-8 AM) Was recorded 2 days to 4 days after noninvasive ventilation initiation. Late noninvasive ventilation failure was defined as death, endotracheal intubation, or persistent need for noninvasive ventilation on day 6.Measurements and Main Results: An abnormal electroencephalographic pattern that eluded analysis by standard sleep-scoring criteria was noted in seven (50%) of the 14 patients with late noninvasive ventilation failure compared with one (8%) of the 13 patients successfully treated with noninvasive ventilation (P = .03). No clinical or laboratory variables explained the electroencephalographic differences. Patients failing noninvasive ventilation had poorer sleep quality with greater circadian sleep-cycle disruption and less nocturnal rapid eye movement sleep (6 mins [range, 0-12] vs. 26 mins [range, 6-49], p = .03), compared with patients successfully treated with noninvasive ventilation. Noninvasive ventilation failure was associated with delirium during the intensive care unit stay (64% vs. 0%).Conclusions: Late noninvasive ventilation failure in elderly patients with acute hypercapnic respiratory failure was associated with early sleep disturbances including an abnormal electroencephalographic pattern, disruption of the circadian sleep cycle, and decreased rapid eye movement sleep. (Crit Care Med 2010; 38:477-485)