Liu Jinhua, Duan Jun, Bai Linfu, Zhou Lintong
Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Respir Care. 2016 Mar;61(3):277-84. doi: 10.4187/respcare.04220. Epub 2015 Dec 29.
Noninvasive ventilation (NIV) intolerance is one reason for NIV failure. However, the characteristics, predictors, and outcomes of NIV intolerance are unclear.
A prospective observational study was performed in the respiratory intensive care unit of a teaching hospital. Subjects with acute respiratory failure who used NIV were enrolled. Initially, continuous use of NIV was encouraged. However, if the subject could not tolerate NIV, it was used intermittently. NIV intolerance was defined as termination of NIV due to subject refusal to receive it because of discomfort, even after intermittent use was attempted.
A total of 961 subjects were enrolled in the study. Of these, 50 subjects (5.2%) experienced NIV intolerance after a median 2.4 h of NIV support. Age (OR = 0.98, 95% CI 0.963-0.996) and heart rate (OR = 1.02, 95% CI 1.006-1.030) measured before NIV were 2 independent risk factors of NIV intolerance. After 1-2 h of NIV, independent risk factors of NIV intolerance were heart rate (OR = 1.03, 95% CI 1.016-1.044) and breathing frequency (OR = 1.06, 95% CI 1.027-1.099). Intolerant subjects had no improvement in mean arterial pressure, heart rate, or breathing frequency after the NIV intervention. Moreover, intolerant subjects had a higher intubation rate (44.0% vs 25.8%, P = .008) and higher mortality (34.0% vs 22.4%, P = .08). The three most common complaints were that NIV worsened subjects' distress (46%), that NIV resulted in dyspnea (26%), and that the flow or pressure of NIV was too strong to bear (16%).
NIV intolerance worsened subjects' outcomes. Younger subjects with a high heart rate and breathing frequency may be more likely to experience NIV intolerance.
无创通气（NIV）不耐受是NIV失败的原因之一。然而，NIV不耐受的特征、预测因素和结果尚不清楚。
在一家教学医院的呼吸重症监护病房进行了一项前瞻性观察研究。纳入使用NIV的急性呼吸衰竭患者。最初，鼓励持续使用NIV。然而，如果患者不能耐受NIV，则间歇使用。NIV不耐受定义为即使尝试间歇使用后，患者仍因不适拒绝接受NIV而导致NIV终止。
共961名患者纳入研究。其中，50名患者（5.2%）在接受NIV支持中位数2.4小时后出现NIV不耐受。NIV前测量的年龄（OR = 0.98，95%CI 0.963 - 0.996）和心率（OR = 1.02，95%CI 1.006 - 1.030）是NIV不耐受的2个独立危险因素。NIV 1 - 2小时后，NIV不耐受的独立危险因素是心率（OR = 1.03，95%CI 1.016 - 1.044）和呼吸频率（OR = 1.06，95%CI 1.02７ - 1.099）。不耐受的患者在NIV干预后平均动脉压、心率或呼吸频率无改善。此外，不耐受的患者插管率更高（44.0%对25.8%，P = 0.008），死亡率更高（34.0%对22.4%，P = 0.08）。最常见的三个主诉是NIV加重了患者的痛苦（46%）、NIV导致呼吸困难（26%）以及NIV的流量或压力过大难以忍受（１６%）。
NIV不耐受会使患者的预后恶化。心率和呼吸频率较高的年轻患者可能更易出现NIV不耐受。
