Schettino Guilherme, Altobelli Neila, Kacmarek Robert M
Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
Crit Care Med. 2008 Feb;36(2):441-7. doi: 10.1097/01.CCM.0000300084.67277.90.
Noninvasive positive-pressure ventilation (NPPV) has been shown to be effective in select patients enrolled in clinical trials. However, few data are available on the use of NPPV as routine standard medical care for patients with respiratory failure outside of controlled trials.
All patients receiving NPPV for a 1-yr period for acute or acute on chronic respiratory failure who did not select do not intubate/resuscitate status were evaluated. Demographic, physiological, and laboratory data were collected for as long as NPPV was provided. Data were recorded on 449 patients. Intubation rate was 18%, 24%, 38%, 40%, and 60%, respectively, for patients with cardiogenic pulmonary edema (n = 97), acute exacerbation of chronic obstructive pulmonary disease (n = 87), non-chronic obstructive pulmonary disease acute hypercapnic respiratory failure (n = 35), postextubation respiratory failure patients (n = 95), and acute hypoxemic respiratory failure (n = 144). The hospital mortality for patients with acute hypoxemic respiratory failure who failed NPPV was 64%. A logistic regression showed that baseline Simplified Acute Physiology Score II (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.05-1.10; p <.0001), Glasgow Coma Scale (OR, 0.76; 95% CI, 0.66-0.87; p <.0001), PaO2/FIO2 ratio (OR, 0.98; 95% CI, 0.93-0.99; p = .02), and serum albumin (OR, 0.30; 95% CI, 0.16-0.57; p < .001) were the variables associated with NPPV failure.
NPPV as routine standard medical care resulted in the intubation of a similar percentage of patients with respiratory failure due to cardiogenic pulmonary edema and chronic obstructive pulmonary disease exacerbation as shown in randomized controlled trials but in a higher percent of patients with hypoxemic respiratory failure than reported in these trials. NPPV failure was associated with high hospital mortality for patients with hypoxemic respiratory failure.
无创正压通气（NPPV）已被证明在参与临床试验的特定患者中有效。然而，关于在对照试验之外将NPPV用作呼吸衰竭患者常规标准医疗护理的数据却很少。
对所有在1年期间因急性或慢性呼吸衰竭接受NPPV治疗且未选择不插管/不复苏状态的患者进行评估。只要提供NPPV，就收集人口统计学、生理学和实验室数据。记录了449例患者的数据。心源性肺水肿患者（n = 97）、慢性阻塞性肺疾病急性加重患者（n = 87）、非慢性阻塞性肺疾病急性高碳酸血症呼吸衰竭患者（n = 35）、拔管后呼吸衰竭患者（n = 95）和急性低氧血症呼吸衰竭患者（n = 144）的插管率分别为18%、24%、38%、40%和60%。NPPV治疗失败的急性低氧血症呼吸衰竭患者的医院死亡率为64%。逻辑回归显示，基线简化急性生理学评分II（比值比[OR]，1.07；95%置信区间[CI]，1.05 - 1.10；p <.0001）、格拉斯哥昏迷量表（OR，0.76；95% CI，0.66 - 0.87；p <.0001）、PaO2/FIO2比值（OR，0.98；95% CI，0.93 - 0.99；p =.02）和血清白蛋白（OR，0.30；95% CI，0.16 - 0.57；p <.001）是与NPPV失败相关的变量。
作为常规标准医疗护理，NPPV导致心源性肺水肿和慢性阻塞性肺疾病加重所致呼吸衰竭患者的插管率与随机对照试验中所示相似，但低氧血症呼吸衰竭患者的插管率高于这些试验中的报告。NPPV失败与低氧血症呼吸衰竭患者的高医院死亡率相关。
