Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
J Anesth. 2011 Feb;25(1):42-9. doi: 10.1007/s00540-010-1051-x. Epub 2010 Dec 9.
Noninvasive positive pressure ventilation (NPPV) has been suggested to be associated with adverse outcomes in emergency patients with acute respiratory failure (ARF), possibly because of a delay in tracheal intubation (TI). We hypothesized that protocol-based NPPV (pNPPV) might improve the outcomes, compared with individual physician-directed NPPV (iNPPV).
To guide decision making regarding the use of NPPV, we developed an NPPV protocol. Observational data were collected before and after protocol implementation in consecutive patients with ARF and compared between the pNPPV and the iNPPV groups.
The results for pNPPV (n = 37) were compared with those for iNPPV (n = 37). No significant baseline differences in patient characteristics were observed between the two groups except for mean age, which was higher in the pNPPV group than in the iNPPV group (P = 0.02). Rate of TI and duration of mechanical ventilation were similar in the two groups. However, the time from the start of NPPV until TI tended to be shorter in the pNPPV group than in the iNPPV group (P = 0.11). The hospital mortality rate was significantly lower in the pNPPV group than in the iNPPV group (P = 0.049). Although the length of hospital stay was shorter in the pNPPV group than in the iNPPV group, this trend did not reach statistical significance (P = 0.14).
The present study suggests that pNPPV is effective and likely to improve the mortality rate of emergency patients with ARF.
有研究表明，无创正压通气（NPPV）与急性呼吸衰竭（ARF）急诊患者的不良结局相关，这可能是由于气管插管（TI）延迟所致。我们假设，基于方案的 NPPV（pNPPV）可能比个体医生指导的 NPPV（iNPPV）改善结局。
为了指导 NPPV 使用的决策，我们制定了 NPPV 方案。在 ARF 连续患者中，在方案实施前后收集观察性数据，并在 pNPPV 和 iNPPV 组之间进行比较。
将 pNPPV（n=37）的结果与 iNPPV（n=37）的结果进行比较。除平均年龄外，两组患者的特征无显著基线差异，pNPPV 组的平均年龄高于 iNPPV 组（P=0.02）。两组患者的 TI 率和机械通气持续时间相似。然而，pNPPV 组从 NPPV 开始到 TI 的时间似乎短于 iNPPV 组（P=0.11）。pNPPV 组的住院死亡率明显低于 iNPPV 组（P=0.049）。尽管 pNPPV 组的住院时间短于 iNPPV 组，但这一趋势未达到统计学意义（P=0.14）。
本研究表明，pNPPV 是有效的，可能会改善 ARF 急诊患者的死亡率。
