Lefebvre Aurélie, Lorut Christine, Alifano Marco, Dermine Hervé, Roche Nicolas, Gauzit Rémy, Regnard Jean-François, Huchon Gérard, Rabbat Antoine
Department of Respiratory and Intensive Care Medicine, Hôtel-Dieu Hospital, AP-HP, Université Paris 5, René Descartes, Paris, France.
Intensive Care Med. 2009 Apr;35(4):663-70. doi: 10.1007/s00134-008-1317-z. Epub 2008 Oct 14.
A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome.
We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation.
Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P < 0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5; 95% confidence interval, 1.9-68.3; P = 0.007) and no initial response to NIV (odds ratio, 117.6; 95% confidence interval, 10.6-1305.8; P = 0.0001).
This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection.
一项前瞻性随机研究发现，在部分肺切除术后发生急性呼吸衰竭（ARF）的患者中，无创通气（NIV）可减少气管插管机械通气的需求并改善临床结局。
我们在一所大学医院的内科和外科重症监护病房环境中，对4年期间肺切除术后ARF患者早期使用NIV进行了前瞻性评估。我们记录了人口统计学资料、初始临床特征和临床结局。NIV失败定义为需要气管插管。
在690例有肺切除术后严重并发症风险的患者中，113例（16.3%）发生ARF，其中89例（78.7%）最初接受NIV支持，包括59例低氧性ARF（66.3%）和30例高碳酸血症性ARF（33.7%）。NIV的总体成功率为85.3%（76/89）。重症监护病房内死亡率为6.7%（6/89）。NIV失败后的死亡率为46.1%。单因素分析中NIV失败的预测因素为年龄（P = 0.046）、既往心脏合并症（P = 0.0075）、术后肺炎（P = 0.0016）、入住外科重症监护病房（P = 0.034）、对NIV无初始反应（P < 0.0001）和发生非感染性并发症（P = 0.037）。多因素分析中仅两个独立因素与NIV失败显著相关：心脏合并症（比值比，11.5；95%置信区间，1.9 - 68.3；P = 0.007）和对NIV无初始反应（比值比，117.6；95%置信区间，10.6 - 1305.8；P = 0.0001）。
这项前瞻性调查证实了NIV在肺切除术后ARF中的可行性和有效性。
