Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Respir Care. 2012 Jul;57(7):1145-53. doi: 10.4187/respcare.01541. Epub 2012 Jan 23.
There is paucity of data from India on the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF). In this observational study, we report the indications and outcomes of patients requiring NIV in the respiratory ICU of a tertiary care hospital.
All patients with ARF requiring NIV were included in the study. NIV was delivered through critical care ventilators, using oronasal mask. The disease severity and new-onset organ dysfunction/failure were calculated using the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, respectively. A multivariate logistic regression model was used to analyze the factors predicting NIV failure.
There were 92 subjects (48 men, 44 women, mean ± SD age 48 ± 17.5 y) who received 101 NIV applications (42 and 59 applications for episodes of hypoxemic and hypercapnic ARF, respectively) during the study period. The most common causes of hypoxemic and hypercapnic respiratory failure were acute lung injury/ARDS (29%) and COPD (29%), respectively. There was significant improvement in heart rate and respiratory rate after 1, 2, and 4 hours, compared to the baseline, in both the groups. Of the NIV applications, 53.5% required endotracheal intubation, with the number being significantly higher in hypoxemic (67%), compared to hypercapnic (44%), ARF (P = .03). The P(aO(2))/F(IO(2)) measured after 1 hour of NIV application had significant impact on outcome in patients with hypoxemic but not hypercapnic ARF. A P(aO(2))/F(IO(2)) of ≤ 146 mm Hg at one hour had a better specificity (85.7% vs 71.4%), versus a P(aO(2))/F(IO(2)) of ≤ 175 mm Hg in predicting NIV failure in patients with hypoxemic ARF. On multivariate logistic regression analysis, baseline APACHE II score, ΔSOFA score, hypoxemic respiratory failure, and change in P(aO(2))/F(IO(2)) at 1 hour from baseline were associated with NIV failure.
NIV was found to be a useful modality in management of patients with hypercapnic versus hypoxemic respiratory failure. The severity of illness at admission, new-onset organ dysfunction, hypoxemic ARF, and delay in improvement in P(aO(2))/F(IO(2)) at 1 hour from baseline are independent predictors of NIV failure.
印度缺乏关于无创通气（NIV）在急性呼吸衰竭（ARF）中的应用的数据。在这项观察性研究中，我们报告了在三级护理医院的呼吸重症监护病房中需要 NIV 的患者的适应证和结局。
所有需要 NIV 的 ARF 患者均纳入本研究。通过使用口鼻面罩的重症监护呼吸机提供 NIV。疾病严重程度和新发器官功能/衰竭分别使用急性生理学和慢性健康评估（APACHE II）和序贯器官衰竭评估（SOFA）评分来计算。使用多变量逻辑回归模型分析预测 NIV 失败的因素。
研究期间共有 92 例患者（48 例男性，44 例女性，平均年龄 48 ± 17.5 岁）接受了 101 次 NIV 应用（分别为 42 次和 59 次用于低氧血症和高碳酸血症 ARF 发作）。低氧血症和高碳酸血症呼吸衰竭的最常见原因分别是急性肺损伤/ARDS（29%）和 COPD（29%）。与基线相比，两组在 1、2 和 4 小时后心率和呼吸率均显著改善。NIV 应用中有 53.5%需要气管插管，低氧血症（67%）明显高于高碳酸血症（44%）（P =.03）。在接受 NIV 治疗 1 小时后测量的 P(aO(2))/F(IO(2))对低氧血症 ARF 患者的结局有显著影响，但对高碳酸血症 ARF 患者没有影响。在低氧血症 ARF 患者中，1 小时时 P(aO(2))/F(IO(2))≤146 mmHg 的特异性（85.7%比 71.4%）优于 P(aO(2))/F(IO(2))≤175 mmHg（P=.03），预测 NIV 失败。多变量逻辑回归分析显示，基线 APACHE II 评分、ΔSOFA 评分、低氧血症呼吸衰竭以及从基线开始 1 小时时 P(aO(2))/F(IO(2))的变化与 NIV 失败相关。
NIV 被证明是治疗高碳酸血症与低氧血症呼吸衰竭患者的有效方法。入院时的疾病严重程度、新发器官功能障碍、低氧血症 ARF 以及从基线开始 1 小时时 P(aO(2))/F(IO(2))改善延迟是 NIV 失败的独立预测因素。
