Anaesthesiology and Surgical Critical Care Department, Lyon University Croix Rousse Hospital, Lyon, France.
Eur J Anaesthesiol. 2010 Mar;27(3):270-4. doi: 10.1097/EJA.0b013e32832dbd49.
Few data are available on the efficacy of noninvasive ventilation (NIV) in postoperative patients with acute respiratory failure (ARF).
Seventy-two patients coming from the surgical wards with postoperative ARF were retrospectively evaluated. The major characteristics of patients who were intubated were compared with the characteristics of those who were not after a trial of NIV. Predictive factors for failure of NIV were analysed.
Out of 72 patients with ARF after surgery who were treated with NIV, 42 avoided intubation (58%). On a univariate analysis, a decrease in the paO2/FiO2 ratio after 1 h of NIV (223 +/- 84 to 160 +/- 68 mmHg, P < 0.05) was associated with NIV failure and need for tracheal intubation because of nosocomial pneumonia and an increased simplified acute physiology score (SAPS) 2. In a multivariate analysis, nosocomial pneumonia [odds ratio (OR) 4.189; 95% confidence interval (CI) 1.383-12.687] and SAPS 2 higher than 35 (OR 4.969; 95% CI 1.627-15.172) were independent predictive factors of NIV failure. NIV success was associated with a reduced ICU stay (16.8 vs. 26.1 days, P < 0.001).
NIV could be considered in postoperative patients who presented with ARF. Nosocomial pneumonia is predictive of NIV failure.
关于无创通气（NIV）在术后急性呼吸衰竭（ARF）患者中的疗效，目前仅有少量数据。
回顾性评估了 72 名来自外科病房的术后 ARF 患者。比较了接受 NIV 试验的患者与未接受 NIV 试验的患者的主要特征。分析了 NIV 失败的预测因素。
72 名接受 NIV 治疗的术后 ARF 患者中，有 42 名（58%）避免了插管。单因素分析显示，NIV 后 1 小时 paO2/FiO2 比值下降（223 ± 84 至 160 ± 68 mmHg，P < 0.05）与 NIV 失败和因医院获得性肺炎需要气管插管以及简化急性生理学评分（SAPS）2 升高有关。多因素分析显示，医院获得性肺炎[比值比（OR）4.189；95%置信区间（CI）1.383-12.687]和 SAPS 2 高于 35（OR 4.969；95% CI 1.627-15.172）是 NIV 失败的独立预测因素。NIV 成功与 ICU 住院时间缩短相关（16.8 天与 26.1 天，P < 0.001）。
NIV 可用于出现 ARF 的术后患者。医院获得性肺炎是 NIV 失败的预测因素。
