Passarini Juliana Nalin de Souza, Zambon Lair, Morcillo André Moreno, Kosour Carolina, Saad Ivete Alonso Bredda
Rev Bras Ter Intensiva. 2012 Sep;24(3):278-83.
This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service.
This study was a prospective, descriptive and analytical study. We included patients of both genders aged >18 years who used non-invasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH2O and inspiratory pressures between 10 and 12 cmH2O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation.
A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 - 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2 - 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (p<0.001). BiPAP (Bi-level Positive Airway Pressure portable ventilator), as continuous positive airway pressure use increased the probability of endotracheal intubation 2.3 times (p=0.032). Patients with acute pulmonary edema and elevated GCS scores also increased the probability of success.
Respiratory frequency >25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO2 values were associated with NIV success. Non-invasive mechanical ventilation can be used in emergency services in acute respiratory failure cases caused by acute pulmonary edema and chronic obstructive pulmonary disease exacerbation, but patients with variables related to a higher percentage of endotracheal intubation should be specially monitored.
本研究分析了无创机械通气治疗急性肺水肿及慢性阻塞性肺疾病急性加重所致的急性呼吸衰竭，以确定在急诊和急救服务中与无创机械通气成功或失败相关的因素。
本研究为前瞻性、描述性和分析性研究。纳入年龄>18岁因急性肺水肿或慢性阻塞性肺疾病急性加重继发急性呼吸衰竭而使用无创机械通气的男女患者。排除因急性肺水肿和慢性阻塞性肺疾病以外的其他病理因素继发急性呼吸衰竭或存在该技术禁忌证的患者。呼气压力为5至8厘米水柱，吸气压力为10至12厘米水柱。补充氧气使外周血氧饱和度维持在>90%。主要结局为气管插管。
共纳入152例患者。慢性阻塞性肺疾病患者（n = 60）无创机械通气的中位时间为6小时（范围为1 - 32小时），急性肺水肿患者（n = 92）为5小时（范围为2 - 32小时）。大多数（75.7%）患者成功好转。然而，观察到急性生理与慢性健康状况评分系统（APACHE II）评分降低和外周血氧饱和度降低。这些结果在进展为气管插管的患者中具有统计学意义（p<0.001）。双水平气道正压通气（BiPAP）便携式呼吸机，随着持续气道正压通气的使用，气管插管的概率增加了2.3倍（p = 0.032）。急性肺水肿且格拉斯哥昏迷量表（GCS）评分升高的患者成功概率也增加。
呼吸频率>25次/分钟、较高的APACHE II评分、使用BiPAP和慢性阻塞性肺疾病诊断与气管插管相关。较高的GCS和血氧饱和度（SpO2）值与无创通气成功相关。无创机械通气可用于急性肺水肿和慢性阻塞性肺疾病急性加重所致急性呼吸衰竭的急救服务，但应特别监测与较高气管插管百分比相关变量的患者。
