Yamauchi Liria Yuri, Figueiroa Maise, da Silveira Leda Tomiko Yamada, Travaglia Teresa Cristina Francischetto, Bernardes Sidnei, Fu Carolina
Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, BR.
Departamento de Fisioterapia, Ciências da Comunicação e Desordens e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
Rev Bras Ter Intensiva. 2015 Jul-Sep;27(3):252-9. doi: 10.5935/0103-507X.20150046.
To describe post-extubation noninvasive positive pressure ventilation use in intensive care unit clinical practice and to identify factors associated with noninvasive positive pressure ventilation failure.
This prospective cohort study included patients aged ≥ 18 years consecutively admitted to the intensive care unit who required noninvasive positive pressure ventilation within 48 hours of extubation. The primary outcome was noninvasive positive pressure ventilation failure.
We included 174 patients in the study. The overall noninvasive positive pressure ventilation use rate was 15%. Among the patients who used noninvasive positive pressure ventilation, 44% used it after extubation. The failure rate of noninvasive positive pressure ventilation was 34%. The overall mean ± SD age was 56 ± 18 years, and 55% of participants were male. Demographics; baseline pH, PaCO2 and HCO3; and type of equipment used were similar between groups. All of the noninvasive positive pressure ventilation final parameters were higher in the noninvasive positive pressure ventilation failure group [inspiratory positive airway pressure: 15.0 versus 13.7 cmH2O (p = 0.015), expiratory positive airway pressure: 10.0 versus 8.9 cmH2O (p = 0.027), and FiO2: 41 versus 33% (p = 0.014)]. The mean intensive care unit length of stay was longer (24 versus 13 days), p < 0.001, and the intensive care unit mortality rate was higher (55 versus 10%), p < 0.001 in the noninvasive positive pressure ventilation failure group. After fitting, the logistic regression model allowed us to state that patients with inspiratory positive airway pressure ≥ 13.5 cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure compared with individuals with inspiratory positive airway pressure < 13.5 (OR = 3.02, 95%CI = 1.01 - 10.52, p value = 0.040).
The noninvasive positive pressure ventilation failure group had a longer intensive care unit length of stay and a higher mortality rate. Logistic regression analysis identified that patients with inspiratory positive airway pressure ≥ 13.5 cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure.
描述重症监护病房临床实践中拔管后无创正压通气的使用情况，并确定与无创正压通气失败相关的因素。
这项前瞻性队列研究纳入了年龄≥18岁、连续入住重症监护病房且在拔管后48小时内需要无创正压通气的患者。主要结局为无创正压通气失败。
我们纳入了174例患者进行研究。无创正压通气的总体使用率为15%。在使用无创正压通气的患者中，44%在拔管后使用。无创正压通气的失败率为34%。总体平均年龄±标准差为56±18岁，55%的参与者为男性。两组之间的人口统计学特征、基线pH值、动脉血二氧化碳分压和碳酸氢根以及使用的设备类型相似。无创正压通气失败组的所有无创正压通气最终参数均较高[吸气气道正压：15.0对13.7 cmH₂O（p = 0.015），呼气气道正压：10.0对8.9 cmH₂O（p = 0.027），以及吸入氧浓度：41%对33%（p = 0.014）]。无创正压通气失败组的重症监护病房平均住院时间更长（24天对13天），p < 0.001，且重症监护病房死亡率更高（55%对10%），p < 0.001。拟合后，逻辑回归模型使我们能够指出，在无创正压通气支持最后一天吸气气道正压≥13.5 cmH₂O的患者发生无创正压通气失败的可能性是吸气气道正压<13.5 cmH₂O患者的三倍（比值比=3.02，95%置信区间=1.01 - 10.52，p值=0.040）。
无创正压通气失败组的重症监护病房住院时间更长，死亡率更高。逻辑回归分析确定，在无创正压通气支持最后一天吸气气道正压≥13.5 cmH₂O的患者发生无创正压通气失败的可能性是其三倍。
