Réanimation médicale, Medical ICU, Hôpital Saint-Louis, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France,
Intensive Care Med. 2014 Apr;40(4):582-91. doi: 10.1007/s00134-014-3222-y. Epub 2014 Feb 7.
Noninvasive ventilation (NIV) had proven benefits in clinical trials that included selected patients admitted to highly skilled centers. Whether these benefits apply to every patient and in everyday practice deserves appraisal. The aim of the study was to assess the use and outcomes of NIV over the last 15 years.
Multicenter database study of critically ill patients who required ventilatory support for acute respiratory failure between 1997 and 2011. The impact of first-line NIV on 60-day mortality was evaluated using a marginal structural model. Follow-up was censored on day 60.
Of 3,163 patients, 1,232 (39 %) received NIV. Over the study period, first-line NIV increased from 29 to 42 %, and NIV success rates increased from 69 to 84 %. NIV decreased 60-day mortality [adjusted hazard ratio (aHR), 0.75; 95 % confidence interval (95 % CI), 0.68-0.83; P < 0.0001]. This protective effect was observed in patients with acute-on-chronic respiratory failure (aHR, 0.71; 95 % CI, 0.57-0.90; P = 0.004), but not in patients with cardiogenic pulmonary edema (aHR, 0.85; 95 % CI, 0.70-1.03; P = 0.10) or in patients with hypoxemic ARF, either immunocompetent (aHR, 1.18; 95 % CI, 0.87-1.59; P = 0.30) or immunocompromised (aHR, 0.89; 95 % CI, 0.70-1.13; P = 0.35). NIV failure was an independent time-dependent risk factor for mortality (aHR, 4.2; 95 % CI, 2.8-6.2; P < 0.0001).
The use of NIV increased steadily over the study period. First-line NIV was associated with better 60-day survival and fewer ICU-acquired infections compared to first-line intubation. Survival benefits from NIV occurred only in patients with acute-on-chronic respiratory failure and immunocompromised patients.
无创通气（NIV）在包括选择的入住高技能中心的患者的临床试验中已被证明具有益处。这些益处是否适用于每个患者以及日常实践，值得评估。本研究的目的是评估过去 15 年中 NIV 的使用情况和结果。
对 1997 年至 2011 年间因急性呼吸衰竭需要通气支持的危重病患者进行多中心数据库研究。使用边缘结构模型评估一线 NIV 对 60 天死亡率的影响。随访截止于第 60 天。
在 3163 名患者中，有 1232 名（39％）接受了 NIV。在研究期间，一线 NIV 的使用率从 29％增加到 42％，NIV 成功率从 69％增加到 84％。NIV 降低了 60 天死亡率[调整后的危险比（aHR），0.75；95％置信区间（95％CI），0.68-0.83；P<0.0001]。这种保护作用在慢性呼吸衰竭急性加重患者中观察到（aHR，0.71；95％CI，0.57-0.90；P=0.004），但在心源性肺水肿患者中未观察到（aHR，0.85；95％CI，0.70-1.03；P=0.10）或低氧性 ARF 患者中未观察到（免疫功能正常的患者 aHR，1.18；95％CI，0.87-1.59；P=0.30）或免疫功能低下的患者（aHR，0.89；95％CI，0.70-1.13；P=0.35）。NIV 失败是死亡率的独立时间依赖性危险因素（aHR，4.2；95％CI，2.8-6.2；P<0.0001）。
在研究期间，NIV 的使用稳步增加。与一线插管相比，一线 NIV 与 60 天生存率的提高和 ICU 获得性感染的减少相关。NIV 的生存获益仅发生在慢性呼吸衰竭急性加重和免疫功能低下的患者中。
