The Effect of Noninvasive Ventilation Support on COVID-19 Patients and Risk Factors for Invasive Ventilation - A Retrospective and Multicenter Study.
The Effect of Noninvasive Ventilation Support on COVID-19 Patients and Risk Factors for Invasive Ventilation - A Retrospective and Multicenter Study.
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DOI：
10.2147/ijgm.s327429
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发表时间：
2021
影响因子：
2.3
通讯作者：
Chen P
中科院分区：
文献类型：
--
作者：
Zhou A;Song Q;Peng Y;Deng D;Liao X;Huang P;Liu W;Xiang Z;Liu Q;Jiang M;Huang X;Xiang X;Peng H;Chen P
氧疗(OT)是严重急性呼吸综合征冠状病毒(SARS-CoV-2)感染所致的低氧性急性呼吸衰竭(ARF)患者最常用的支持疗法。本研究的目的是确定无创机械通气支持对冠状病毒病2019(新冠肺炎)患者的影响以及有创机械通气的危险因素。我们对武汉以外9家医院确诊的新冠肺炎患者进行了回顾性分析。纳入2020年1月1日至3月31日实时荧光定量聚合酶链式反应检测新冠肺炎阳性的住院患者。根据最先进的OT方案，将患者分为4组，包括无OT组、鼻氧组、高流量鼻氧组(HFNOT)或无创通气组(NIV)和IMV组。采用多因素Logistic回归模型分析IMV的危险因素。在招募的683名受试者中，315名(46.1%)不需要OT，300名(43.9%)接受鼻氧疗，51名(7.5%)接受HFNOT或NIV，17名(2.5%)需要插管。OT组乳酸水平高于非OT组(2.7vs1.6，P=0.02)。此外，高血压性肾炎或硝酸甘油患者呼吸频率较高，但PaO2较低(P<；0.001)。高频地塞米松和硝普钠对急性肾衰有明显的治疗作用，75%的新冠肺炎患者呼吸衰竭痊愈。与未插管的患者相比，有IMV的患者年龄更大(P<；0.001)，高血压的发生率(P<；0.001)更高，继发性细菌感染更多(P<；0.001)。多因素模型显示继发细菌感染(OR=6.87，P=0.009)是新冠肺炎患者IMV失败的独立危险因素。我们发现高压诺和硝普钠对新冠肺炎患者的急性肾功能衰竭有明显的有利作用。我们还证明，在感染SARS-COV2的患者中，继发性细菌感染是NIV失败的独立危险因素。
Oxygen therapy (OT) is the most widely used supportive regime in patients with hypoxemic acute respiratory failure (ARF) due to severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. The aim of this study was to identify the effect of noninvasive ventilation support on coronavirus disease 2019 (COVID-19) patients and risk factors for invasive mechanical ventilation (IMV). We retrospectively analyzed confirmed COVID-19 subjects from nine hospitals outside Wuhan. All hospitalized patients who tested positive for COVID-19 by real-time polymerase chain reaction between January 1st and March 31st, 2020, were recruited. The patients were divided into four groups based on the most advanced OT regime, including no OT, nasal oxygen therapy, high-flow nasal oxygen therapy (HFNOT) or noninvasive ventilation (NIV), and IMV. Multiple logistic regression models were performed to determine risk factors for IMV. Of the 683 recruited subjects, 315 (46.1%) subjects did not need OT, 300 (43.9%) received nasal oxygen therapy, 51 (7.5%) received HFNOT or NIV, while 17 (2.5%) subjects had to be intubated. The lactate in the OT group was higher than in the no OT group (2.7 vs 1.6, P = 0.02). In addition, HFNOT or NIV patients had a higher respiratory rate, but a lower PaO2 (P < 0.001). HFNOT and NIV had an obvious beneficial effect on ARF with 75% of COVID-19 patients recovering from respiratory failure. Patients with IMV were older (P < 0.001), had a higher rate of hypertension (P < 0.001) and more secondary bacterial infections (P < 0.001) compared to those without intubation. The multivariate model showed that secondary bacterial infection (OR = 6.87, P = 0.009) was independently associated with IMV failure among COVID-19 patients. We identified that HFNOT and NIV had an obvious beneficial effect on ARF among COVID-19 patients. We also demonstrated that secondary bacterial infection was an independent risk factor for NIV failure in patients infected by SARS-COV2.