Department of Medicine, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China.
BMC Emerg Med. 2013 Apr 9;13:6. doi: 10.1186/1471-227X-13-6.
Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study.
We conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (≥18 years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded.
Out of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 60-84), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment.
Our results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment.
无创机械通气（NIV）是重症监护病房急性呼吸衰竭（ARF）管理的一线治疗方法。然而，关于 ARF 患者使用 NIV 的相关因素和结局的数据尚缺乏。因此，我们旨在通过一项基于人群的研究来确定 NIV 在 ARF 患者中的应用情况。
我们进行了一项基于人群的回顾性队列研究，研究对象为 2006 年在明尼苏达州罗切斯特市梅奥诊所内科和外科重症监护病房连续收治的所有年龄≥18 岁的 ARF 成年患者。排除未获得研究授权或因睡眠呼吸暂停而长期使用 NIV 的患者。
在 2006 年入住重症监护病房的 1461 名奥姆斯特德县成年居民中，有 364 名患者发生 ARF，其中 146 名患者开始使用 NIV。患者的中位年龄为 75 岁（四分位间距 60-84 岁），48%为女性，88.7%为白种人。18 名患者（12%）使用持续气道正压通气（CPAP）模式，128 名患者（88%）使用无创间歇正压通气（NIPPV）模式。46 名（10%）ARF 患者因姑息治疗策略而使用 NIV 以缓解呼吸困难。76 名无治疗限制的 ARF 患者接受了 NIV 治疗试验，其中 49 名患者成功，27 名患者需要插管。初始接受 NIV 支持与接受有创机械通气的患者死亡率相似（33%比 22%，P=0.289）。多变量分析显示，急性呼吸窘迫综合征（ARDS）的发生和较高的急性生理与慢性健康评分 III（APACHE III）评分与初始 NIV 治疗失败相关。
我们的研究结果对于美国郊区社区未来规划 NIV 具有重要意义，因为该社区可以获得较高水平的重症监护服务。较高的 APACHE III 评分和 ARDS 的发生与初始 NIV 治疗失败相关。
