Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome
Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome
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DOI：
10.1111/irv.12635
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发表时间：
2019-07-01
影响因子：
4.4
通讯作者：
Arabi, Yaseen M.
中科院分区：
文献类型：
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作者：
Alraddadi, Basem M.;Qushmaq, Ismael;Arabi, Yaseen M.
背景 无创通气（NIV）已用于患有急性低氧性呼吸衰竭的中东呼吸综合征（MERS）患者，但该方法的有效性尚未研究。方法 本次分析纳入了来自 14 个沙特阿拉伯中心的 MERS 患者。将最初接受 NIV 治疗的患者与仅接受有创机械通气（有创 MV）治疗的患者进行比较。结果 在 302 名 MERS 危重患者中，105 名（35%）患者最初使用 NIV，而 197 名（65%）患者仅接受侵入性 MV 治疗。与采用侵入性 MV 治疗的患者相比，最初采用 NIV 治疗的患者基线 SOFA 评分较低，胸片上的浸润范围也较少。绝大多数（92.4%）最初接受 NIV 治疗的患者需要插管和有创机械通气，并且与最初接受有创 MV 治疗的患者相比，更有可能需要吸入一氧化氮。 NIV 患者和侵入性 MV 患者的 ICU 和住院时间相似。 NIV 的使用与 90 天死亡率并不独立相关（倾向评分调整比值比 0.61，95% CI [0.23，1.60] P = 0.27）。结论 在 MERS 合并急性低氧血症性呼吸衰竭的患者中，NIV 失败率非常高。 NIV 的使用与结果改善无关。
Background Noninvasive ventilation (NIV) has been used in patients with the Middle East respiratory syndrome (MERS) with acute hypoxemic respiratory failure, but the effectiveness of this approach has not been studied. Methods Patients with MERS from 14 Saudi Arabian centers were included in this analysis. Patients who were initially managed with NIV were compared to patients who were managed only with invasive mechanical ventilation (invasive MV). Results Of 302 MERS critically ill patients, NIV was used initially in 105 (35%) patients, whereas 197 (65%) patients were only managed with invasive MV. Patients who were managed with NIV initially had lower baseline SOFA score and less extensive infiltrates on chest radiograph compared with patients managed with invasive MV. The vast majority (92.4%) of patients who were managed initially with NIV required intubation and invasive mechanical ventilation, and were more likely to require inhaled nitric oxide compared to those who were managed initially with invasive MV. ICU and hospital length of stay were similar between NIV patients and invasive MV patients. The use of NIV was not independently associated with 90-day mortality (propensity score-adjusted odds ratio 0.61, 95% CI [0.23, 1.60] P = 0.27). Conclusions In patients with MERS and acute hypoxemic respiratory failure, NIV failure was very high. The use of NIV was not associated with improved outcomes.