Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients
Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients
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DOI：
10.1007/s00134-016-4601-3
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发表时间：
2017-02-01
影响因子：
38.9
通讯作者：
Huang, Shicong
中科院分区：
文献类型：
--
作者：
Duan, Jun;Han, Xiaoli;Huang, Shicong
目的：为了开发和验证一个规模使用的变量很容易在床边获得的预测失败的无创通气（NIV）在hypoxemic patients.Methods：测试队列包括449例低氧血症患者接受NIV。该队列用于开发考虑心率、酸中毒、意识、氧合和呼吸频率的量表（称为HACOR量表），以预测NIV失败，定义为NIV干预后需要插管。最高可能得分为25分。为了验证的规模，一个单独的组358低氧血症患者在validation cohol.Results：NIV的失败率分别为47.8%和39.4%，在测试和验证队列。在试验队列中，NIV失败的患者在开始时和NIV后1、12、24和48 h的HACOR评分高于NIV成功的患者。在1小时的NIV的受试者工作特征曲线下的面积为0.88，显示出良好的预测能力NIV失败。以5分为界值，NIV失败的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为72.6%、90.2%、87.2%、78.1%和81.8%。这些结果在验证队列中得到证实。此外，在按诊断、年龄或疾病严重程度分类的亚组中，以及在NIV治疗1、12、24和48 h时，NIV失败的诊断准确率超过80%。在NIV治疗1小时HACOR评分> 5的NIV失败患者中，
Purpose: To develop and validate a scale using variables easily obtained at the bedside for prediction of failure of noninvasive ventilation (NIV) in hypoxemic patients.Methods: The test cohort comprised 449 patients with hypoxemia who were receiving NIV. This cohort was used to develop a scale that considers heart rate, acidosis, consciousness, oxygenation, and respiratory rate (referred to as the HACOR scale) to predict NIV failure, defined as need for intubation after NIV intervention. The highest possible score was 25 points. To validate the scale, a separate group of 358 hypoxemic patients were enrolled in the validation cohort.Results: The failure rate of NIV was 47.8 and 39.4% in the test and validation cohorts, respectively. In the test cohort, patients with NIV failure had higher HACOR scores at initiation and after 1, 12, 24, and 48 h of NIV than those with successful NIV. At 1 h of NIV the area under the receiver operating characteristic curve was 0.88, showing good predictive power for NIV failure. Using 5 points as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for NIV failure were 72.6, 90.2, 87.2, 78.1, and 81.8%, respectively. These results were confirmed in the validation cohort. Moreover, the diagnostic accuracy for NIV failure exceeded 80% in subgroups classified by diagnosis, age, or disease severity and also at 1, 12, 24, and 48 h of NIV. Among patients with NIV failure with a HACOR score of > 5 at 1 h of NIV, hospital mortality was lower in those who received intubation at