Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome Insights from the LUNG SAFE Study
Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome Insights from the LUNG SAFE Study
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DOI：
10.1164/rccm.201606-1306oc
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发表时间：
2017-01-01
影响因子：
24.7
通讯作者：
Pesenti, Antonio
中科院分区：
文献类型：
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作者：
Bellani, Giacomo;Laffey, John G.;Pesenti, Antonio
基本原理：无创通气（NIV）越来越多地用于急性呼吸窘迫综合征（ARDS）患者。支持NIV用于ARDS患者的证据仍然相对sparse.Objectives：要确定是否在NIV期间，根据Pa-O2/FIO 2柏林标准对ARDS严重程度进行分类是有用的。方法：肺安全（了解严重急性呼吸衰竭全球影响的大型观察性研究）研究描述了ARDS患者的管理。本子研究探讨了目前的做法NIV在ARDS中的使用，thePa（O2）/FIO 2的比率在分类接受NIV的患者的效用，NIV对outcome. Measures和主要结果的影响：2,813例ARDS患者中，436（15.5%）与NIV在第1天和第2天的诊断标准的履行后进行管理。根据PaolFio比率对ARDS严重程度进行分类与呼吸支持强度、NIV失败和重症监护室（ICU）死亡率的增加相关。NIV失败发生在轻度、中度和重度ARDS患者中分别为22.2%、42.3%和47.1%。NIV成功和失败患者的住院死亡率分别为16.1%和45.4%。使用NIV与ICU死亡率增加独立相关（危险比，1.446 [95%置信区间，1.159-1.805D]，但与住院死亡率无关。在倾向匹配分析中，ICU死亡率高于NIV有创通气患者的Pa-O2/FIO 2低于150 mm Hg.Conclusions：NIV用于15%的ARDS患者，无论严重程度类别。在Pa-O2/FIO 2低于150 mm Hg的患者中，NIV似乎与较高的ICU死亡率相关。
Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse.Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the Pa-O2/FIO2 Berlin criteria is useful.Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of thePa(O2)/FIO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome.Measurements and Main Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severitybased on PaolFio, ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159-1.805D, but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a Pa-O2/FIO2 lower than 150 mm Hg.Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a Pa-O2/FIO2 lower than 150 mm Hg.