Department of Cardiology und Angiology, University Hospital of Muenster, Muenster, Germany.
Respir Med. 2012 Nov;106(11):1509-16. doi: 10.1016/j.rmed.2012.08.007. Epub 2012 Sep 1.
International guidelines recommend the use of noninvasive ventilation in immunocompromised patients with acute respiratory failure (ARF). We analyzed failure rates and risk factors for NIV failure in immunocompromised patients.
We retrospectively analyzed 120 immunodeficient patients treated with NIV in our medical ICU from 2005 to 2011. We compared the clinical course and NIV failure rates. Furthermore, we compared patients with secondary respiratory failure due to those with Systemic Inflammatory Response Syndrome (SIRS) of other than pulmonary origin to those with primary pulmonary infiltrations.
Regression analyses revealed high APACHE II score (p < 0.01), need for catecholamines (p < 0.05) and low paO(2)/FIO(2) ratio (p < 0.05) as risk factors for NIV failure. Regarding the underlying diseases, we could not find differences in NIV duration (p = 0.07) and outcome (p = 0.44). 59.2% suffered from ARF due to lung infiltrations whereas 40.8% had secondary ARF caused by sepsis of extrapulmonary origin. Patients with lung infiltrations had a longer stay on ICU (16.3 vs 13.2 days; p = 0.047) and showed a trend toward longer NIV duration (87 ± 102 h vs 65.6 ± 97.8 h; p = 0.056). The SIRS patients compared to pneumonia patients showed a trend toward higher serum creatinine (1.63 mg/dL to 1.51 mg/dL; p = 0.059), a higher rate of renal failure (p < 0.01), higher APACHE II score (30.6-25.7, p < 0.01) and more frequently needed catecholamines (p < 0.01). NIV failure rate (overall 55%) was not different.
Almost 50% of the immunocompromised patients treated with NIV did not require intubation independent of the etiology of ARF. High APACHE II scores and severity of oxygenation failure were associated with NIV failure.
国际指南建议对急性呼吸衰竭（ARF）的免疫功能低下患者使用无创通气。我们分析了免疫功能低下患者中无创通气失败的失败率和危险因素。
我们回顾性分析了 2005 年至 2011 年在我们的内科重症监护病房接受无创通气治疗的 120 例免疫缺陷患者。我们比较了临床病程和无创通气失败率。此外，我们比较了继发于非肺部来源全身炎症反应综合征（SIRS）的呼吸衰竭患者与原发性肺部浸润患者。
回归分析显示，高急性生理学和慢性健康状况评分系统 II 评分（p<0.01）、需要儿茶酚胺（p<0.05）和低动脉血氧分压/吸氧分数（p<0.05）是无创通气失败的危险因素。关于基础疾病，我们在无创通气持续时间（p=0.07）和结局（p=0.44）方面没有发现差异。59.2%的患者因肺部浸润而发生 ARF，40.8%的患者因肺外来源的脓毒症继发 ARF。肺部浸润患者在重症监护病房的停留时间更长（16.3 天对 13.2 天；p=0.047），无创通气持续时间也更长（87±102 小时对 65.6±97.8 小时；p=0.056）。与肺炎患者相比，SIRS 患者的血清肌酐呈升高趋势（1.63mg/dL 对 1.51mg/dL；p=0.059），肾衰竭发生率更高（p<0.01），急性生理学和慢性健康状况评分系统 II 评分更高（30.6-25.7，p<0.01），更需要儿茶酚胺（p<0.01）。无创通气失败率（总体为 55%）无差异。
近 50%的接受无创通气治疗的免疫功能低下患者不需要插管，与 ARF 的病因无关。高急性生理学和慢性健康状况评分系统 II 评分和严重程度的氧合衰竭与无创通气失败相关。
