Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, 119074, Singapore.
Intensive Care Med. 2010 Apr;36(4):638-47. doi: 10.1007/s00134-009-1743-6. Epub 2010 Jan 6.
To describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure.
Retrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV.
At baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO(2)/FiO(2) ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO(2)/FiO(2) ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease).
The hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients.
描述支气管扩张症伴急性呼吸衰竭（ARF）患者在保守治疗失败后接受无创通气（NIV）和有创机械通气（IMV）治疗的结果，并确定住院死亡率和 NIV 失败的预测因素。
回顾性分析 8 年来在一家医学重症监护病房（ICU）接受 NIV（n=31）或 IMV（n=26）治疗 ARF 的支气管扩张症患者。
在基线时，NIV 组无明确诱发因素的急性加重患者比例更高（87.1% vs. 34.6%，p<0.001），pH 值更高（平均 7.25 对 7.18，p=0.008），PaO2/FiO2 比值更高（平均 249.4 对 173.2，p=0.02），急性生理学和慢性健康状况评分系统 II（APACHE II）评分较低（平均 25.3 对 28.4，p=0.07）。两组患者的住院死亡率无差异（25.8%对 26.9%，p>0.05）。NIV 失败率（ICU 内需要插管或死亡）为 32.3%。使用逻辑回归，APACHE II 评分是住院死亡率的唯一预测因素（每增加 1 分，OR 1.19），PaO2/FiO2 比值是 NIV 失败的唯一预测因素（每降低 1 mmHg，OR 1.02）。
支气管扩张症伴 ARF 患者的住院死亡率接近 25%，并由 APACHE II 评分预测。当选择性应用时，三分之一的患者 NIV 治疗失败，这由低氧血症预测。我们的研究结果呼吁开展随机对照试验，比较此类患者的 NIV 与 IMV。
