接受无创和/或有创通气治疗的急性慢性呼吸衰竭患者的患病率和预后趋势。
Trends in Prevalence and Prognosis in Subjects With Acute Chronic Respiratory Failure Treated With Noninvasive and/or Invasive Ventilation.
作者信息
Gacouin Arnaud, Jouneau Stephane, Letheulle Julien, Kerjouan Mallory, Bouju Pierre, Fillatre Pierre, Le Tulzo Yves, Tadié Jean Marc
机构信息
Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale Université Rennes I, Faculté de Médecine, Biosit Institut National de la Santé et de la Recherche Médicale CIC-0203, Faculté de Médecine, Université Rennes I, Institut Formation Recherche 40
Centre Hospitalier Universitaire Rennes, Service de Pneumologie Institut de Recherche en Santé, Environnement et Travail 1085, Faculté de Pharmacie, Rennes, France.
出版信息
Respir Care. 2015 Feb;60(2):210-8. doi: 10.4187/respcare.03467. Epub 2014 Nov 18.
BACKGROUND
The pattern and outcome of noninvasive ventilation (NIV) use in patients with acute or chronic respiratory disease other than COPD is not well known. The aims of this study were to investigate trends over time in underlying respiratory diseases, use of NIV, and outcomes in COPD and non-COPD patients with acute respiratory failure.
METHODS
We made a retrospective analysis of data recorded prospectively from 1,113 subjects admitted between 1998 and 2012.
RESULTS
Subject diagnoses were distributed as follows: COPD, n=568 (51%); bilateral bronchiectasis, n=113 (10%); obesity, n=166 (15%); chronic diffuse interstitial lung disease, n=131 (12%); restrictive pulmonary disease, n=113 (10%); and asthma, n=22 (2%). The proportion of subjects with bilateral bronchiectasis significantly decreased (OR 0.91, 95% CI 0.865-0.951, P<.001), whereas the proportion of subjects with obesity increased (OR 1.03, 95% CI 1.001-1.063, P=.049) over time. The use of NIV (OR 1.05, 95% CI 1.010-1.090, P=.01) and the proportion of subjects initially treated with NIV (OR 1.05, 95% CI 1.013-1.094, P=.009) increased significantly in COPD subjects only. Time trend of mortality was not significant (OR 0.98, 95% CI 0.95-1.01, P=.23), whereas the severity of illness in subjects significantly increased. Transition from NIV to invasive mechanical ventilation (IMV) (OR 2.05, 95% CI 1.36-3.11, P=<.001), IMV (OR 10.49, 95% CI 4.88-10.56, P<.001) and diffuse interstitial lung disease (OR 10.63, 95% CI 5.43-20.83, P<.001) were independently associated with death in the ICU.
CONCLUSIONS
Over time, respiratory diseases have changed in non-COPD subjects and trends in the use and efficacy of NIV differ between COPD and non-COPD subjects. Mortality remained stable while the severity of illness in subjects increased. In COPD and non-COPD subjects, transition from NIV to IMV was associated with a poorer prognosis.
背景
慢性阻塞性肺疾病（COPD）以外的急性或慢性呼吸系统疾病患者使用无创通气（NIV）的模式和结果尚不清楚。本研究的目的是调查COPD和非COPD急性呼吸衰竭患者潜在呼吸系统疾病、NIV使用情况及结果随时间的变化趋势。
方法
我们对1998年至2012年间收治的1113例患者的前瞻性记录数据进行了回顾性分析。
结果
患者诊断分布如下：COPD，n = 568（51%）；双侧支气管扩张，n = 113（10%）；肥胖，n = 166（15%）；慢性弥漫性间质性肺疾病，n = 131（12%）；限制性肺疾病，n = 113（10%）；哮喘，n = 22（2%）。随着时间的推移，双侧支气管扩张患者的比例显著下降（比值比[OR]0.91，95%置信区间[CI]0.865 - 0.951，P <.001），而肥胖患者的比例增加（OR 1.03，95% CI 1.001 - 1.063，P =.049）。仅在COPD患者中，NIV的使用（OR 1.05，95% CI 1.010 - 1.090，P =.01）及初始接受NIV治疗的患者比例（OR 1.05，95% CI 1.013 - 1.094，P =.009）显著增加。死亡率的时间趋势不显著（OR 0.98，95% CI 0.95 - 1.01，P =.23），而患者的疾病严重程度显著增加。从NIV转为有创机械通气（IMV）（OR 2.05，95% CI 1.36 - 3.11，P <.001）、IMV（OR 10.49，95% CI 4.88 - 10.56，P <.001）和弥漫性间质性肺疾病（OR 10.63，95% CI 5.43 - 20.83，P <.001）与重症监护病房（ICU）死亡独立相关。
结论
随着时间的推移，非COPD患者的呼吸系统疾病发生了变化，COPD和非COPD患者在NIV使用和疗效方面的趋势有所不同。死亡率保持稳定，而患者的疾病严重程度增加。在COPD和非COPD患者中，从NIV转为IMV与预后较差相关。
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