Pulmonary, Sleep and Critical Care Medicine Division, Creighton University School of Medicine, Omaha, Nebraska 68131, USA.
Respir Care. 2013 May;58(5):778-84. doi: 10.4187/respcare.02096.
Noninvasive ventilation (NIV) has increasingly been used for the treatment of acute respiratory failure. Despite recommendations supporting its utilization in a limited group of patients, NIV is frequently relied on as a first line treatment. We conducted a retrospective study to assess whether the extended use of NIV is associated with worse clinical outcomes.
This was a retrospective review of a data set consisting of patients admitted with respiratory failure and treated with NIV. Based on guidelines, we grouped the patients on whether they had indications and/or contraindications for NIV: NIV indicated and not contraindicated; NIV indicated and contraindicated; NIV not indicated and not contraindicated; NIV not indicated and contraindicated. The need for endotracheal intubation, hospital mortality, and stay were compared between these 4 groups.
Demographic data were not significantly different between the groups. Within the group of subjects with no contraindication for NIV, those with indication and with no indication intubation rates were 28% and 17%, respectively (P = .39). Among the group of subjects with indications for NIV, the rate of intubation was 28% for those with no contraindication and 56% in those with it (P = .13). In the group of subjects with no indication for NIV, the presence of contraindications was associated with higher rate of intubation, compared with those without contraindications (70% vs 17%, P = .002).
This study supports the extended utilization of NIV for subjects without contraindications, and for subjects with indications despite the presence or absence of contraindications.
无创通气（NIV）已越来越多地用于治疗急性呼吸衰竭。尽管有建议支持将其仅用于有限的患者群体，但 NIV 常被作为一线治疗手段。我们进行了一项回顾性研究，以评估 NIV 的广泛应用是否与更差的临床结局相关。
这是一项对一组因呼吸衰竭接受 NIV 治疗的患者数据进行的回顾性分析。根据指南，我们根据患者是否有 NIV 的适应证和/或禁忌证对其进行分组：NIV 适应证且无禁忌证；NIV 适应证但有禁忌证；NIV 无适应证但无禁忌证；NIV 无适应证且有禁忌证。比较这 4 组患者的气管插管需求、住院死亡率和住院时间。
组间的人口统计学数据无显著差异。在无 NIV 禁忌证的患者中，有适应证和无适应证的插管率分别为 28%和 17%（P =.39）。在有 NIV 适应证的患者中，无禁忌证和有禁忌证的插管率分别为 28%和 56%（P =.13）。在无 NIV 适应证的患者中，存在禁忌证与更高的插管率相关，与无禁忌证者相比（70% vs 17%，P =.002）。
本研究支持在无禁忌证的患者中广泛应用 NIV，也支持在存在或不存在禁忌证的情况下对有适应证的患者应用 NIV。
