Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure
Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure
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DOI：
10.1007/s00134-012-2475-6
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发表时间：
2012-03-01
影响因子：
38.9
通讯作者：
Torres, Antoni
中科院分区：
文献类型：
--
作者：
Carrillo, Andres;Gonzalez-Diaz, Gumersindo;Torres, Antoni
社区获得性肺炎（CAP）所致严重急性呼吸衰竭（ARF）患者是否使用无创通气（NIV）存在争议，这些患者无创通气失败的危险因素尚不清楚。我们评估了用NIV治疗CAP和严重ARF患者的特点和预后预测因素。我们前瞻性地评估了184例连续患者；102例有“新生”ARF， 82例既往有心脏或呼吸系统疾病。我们将成功的无创通气定义为避免插管并在重症监护病房（ICU）存活至少24小时。我们通过多变量分析评估了NIV失效和住院死亡率的预测因素。“新生”ARF患者比既往有心脏或呼吸系统疾病的患者更容易失败（47.46%对21.26%,p = 0.007）。入院后24小时放射学浸润恶化，脓毒症相关器官衰竭评估（SOFA）评分最高，NIV 1小时后心率升高、PaO2/FiO降低(2)和碳酸氢盐独立预测NIV衰竭。同样，最大SOFA、NIV失败和年龄较大独立预测住院死亡率。在“新生”ARF插管患者中，住院幸存者的NIV持续时间短于非幸存者（32 +/- A 24小时vs 78 +/- A 65小时，p = 0.014）。本组患者插管前NIV持续时间越长，住院生存率越低（校正优势比0.978,95%可信区间0.962 ~ 0.995,p = 0.012）。在既往有心脏或呼吸系统疾病的患者中未观察到这种关联。成功的NIV与更好的生存率密切相关。如果存在无NIV失败的预测因素，避免延迟插管“新生”ARF患者可能会最大限度地降低死亡率。
The use of non-invasive ventilation (NIV) in severe acute respiratory failure (ARF) due to community-acquired pneumonia (CAP) is controversial, and the risk factors for NIV failure in these patients are not well known. We assessed the characteristics and predictors of outcome of patients with CAP and severe ARF treated with NIV.We prospectively assessed 184 consecutive patients; 102 had "de novo" ARF, and 82 previous cardiac or respiratory disease. We defined successful NIV as avoidance of intubation and intensive care unit (ICU) survival at least 24 h in the ward. We assessed predictors of NIV failure and hospital mortality in multivariate analyses.Patients with "de novo" ARF failed NIV more frequently than patients with previous cardiac or respiratory disease (47, 46% versus 21, 26%, p = 0.007). Worsening radiologic infiltrate 24 h after admission, maximum Sepsis-Related Organ Failure Assessment (SOFA) score and, after 1 h of NIV, higher heart rate and lower PaO2/FiO(2) and bicarbonate independently predicted NIV failure. Likewise, maximum SOFA, NIV failure and older age independently predicted hospital mortality. Among intubated patients with "de novo" ARF, NIV duration was shorter in hospital survivors than non-survivors (32 +/- A 24 versus 78 +/- A 65 h, p = 0.014). In this group, longer duration of NIV before intubation was associated with decreased hospital survival (adjusted odds ratio 0.978, 95% confidence interval 0.962-0.995, p = 0.012). This association was not observed in patients with previous cardiac or respiratory disease.Successful NIV was strongly associated with better survival. If predictors for NIV failure are present, avoiding delayed intubation of patients with "de novo" ARF would potentially minimise mortality.