Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study.
Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study.
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DOI：
10.1186/cc4923
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Gajic O
中科院分区：
文献类型：
--
作者：
Rana S;Jenad H;Gay PC;Buck CF;Hubmayr RD;Gajic O
无创正压通气（NIPPV）在急性肺损伤（ALI）治疗中的作用存在争议。我们试图评估最初使用NIPPV治疗的ALI的结局，并确定NIPPV失败的特定风险因素。在一个三级中心的两个重症监护室进行的这项观察性队列研究中，我们确定了最初接受NIPPV治疗的连续ALI患者。记录人口统计学资料、APACHE III评分、低氧血症程度、ALI危险因素和NIPPV呼吸参数。进行单变量和多变量回归分析，以确定NIPPV失败的风险因素。在79名符合纳入标准的连续患者中，23名因不复苏命令而被排除，2名未给予研究授权。其余54例患者中，38例（70.3%）NIPPV失败，其中19例均发生休克。在逐步Logistic回归中，仅限于无休克、代谢性酸中毒和（比值比1.27，95%置信区间（CI）1.03 - 0.07/单位基础赤字）和重度低氧血症（比值比1.03，动脉氧分压与吸入氧浓度比值（PaO 2/FiO 2）每降低1个单位（95%CI 1.01 - 1.05），可预测NIPPV失败。在NIPPV失败的患者中，观察到的死亡率高于APACHE预测的死亡率（68%对39%，p < 0.01）。对于有休克、代谢性酸中毒或严重低氧血症的ALI患者，应非常谨慎地尝试NIPPV，或根本不尝试。
The role of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute lung injury (ALI) is controversial. We sought to assess the outcome of ALI that was initially treated with NIPPV and to identify specific risk factors for NIPPV failure. In this observational cohort study at the two intensive care units of a tertiary center, we identified consecutive patients with ALI who were initially treated with NIPPV. Data on demographics, APACHE III scores, degree of hypoxemia, ALI risk factors and NIPPV respiratory parameters were recorded. Univariate and multivariate regression analyses were performed to identify risk factors for NIPPV failure. Of 79 consecutive patients who met the inclusion criteria, 23 were excluded because of a do not resuscitate order and two did not give research authorization. Of the remaining 54 patients, 38 (70.3%) failed NIPPV, among them all 19 patients with shock. In a stepwise logistic regression restricted to patients without shock, metabolic acidosis (odds ratio 1.27, 95% confidence interval (CI) 1.03 to 0.07 per unit of base deficit) and severe hypoxemia (odds ratio 1.03, 95%CI 1.01 to 1.05 per unit decrease in ratio of arterial partial pressure of O2 and inspired O2 concentration – PaO2/FiO2) predicted NIPPV failure. In patients who failed NIPPV, the observed mortality was higher than APACHE predicted mortality (68% versus 39%, p < 0.01). NIPPV should be tried very cautiously or not at all in patients with ALI who have shock, metabolic acidosis or profound hypoxemia.
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