Pesaro Antonio Eduardo P, Katz Marcelo, Katz Jason N, Barbas Carmen Sílvia Valente, Makdisse Marcia R, Correa Alessandra G, Franken Marcelo, Pereira Carolina, Serrano Carlos V, Lopes Renato D
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
PLoS One. 2016 Mar 15;11(3):e0151302. doi: 10.1371/journal.pone.0151302. eCollection 2016.
Patients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV.
This was a retrospective observational study in which consecutive patients with AMI (n = 1610) were enrolled. The association between exclusively non-invasive MV, invasive MV and outcomes was assessed by multivariable models.
Mechanical ventilation was used in 293 patients (54% invasive and 46% exclusively non-invasive). In-hospital mortality rates for patients without MV, with exclusively non-invasive MV, and with invasive MV were 4.0%, 8.8%, and 39.5%, respectively (P<0.001). The median lengths of hospital stay were 6 (5.8-6.2), 13 (11.2-4.7), and 28 (18.0-37.9) days, respectively (P<0.001). Exclusively non-invasive MV was not associated with in-hospital death (adjusted HR = 0.90, 95% CI 0.40-1.99, P = 0.79). Invasive MV was strongly associated with a higher risk of in-hospital death (adjusted HR = 3.07, 95% CI 1.79-5.26, P<0.001).
In AMI setting, 18% of the patients required MV. Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death. Future prospective randomized trials are needed to compare the effectiveness of invasive and non-invasive MV for the initial approach of respiratory failure in AMI patients.
急性心肌梗死（AMI）合并呼吸功能障碍的患者可采用有创或无创机械通气（MV）进行治疗。然而，在AMI背景下对无创MV的测试较少。我们的目的是评估接受无创或有创MV治疗的AMI患者的发生率及相关临床结局。
这是一项回顾性观察研究，纳入了连续的AMI患者（n = 1610）。通过多变量模型评估单纯无创MV、有创MV与结局之间的关联。
293例患者使用了机械通气（54%为有创通气，46%为单纯无创通气）。未使用MV、单纯无创MV和有创MV患者的院内死亡率分别为4.0%、8.8%和39.5%（P<0.001）。住院时间中位数分别为6（5.8 - 6.2）天、13（11.2 - 14.7）天和28（18.0 - 37.9）天（P<0.001）。单纯无创MV与院内死亡无关（校正风险比 = 0.90，95%置信区间0.40 - 1.99，P = 0.79）。有创MV与更高的院内死亡风险密切相关（校正风险比 = 3.07，95%置信区间1.79 - 5.26，P<0.001）。
在AMI情况下，18%的患者需要MV。这些患者中近一半采用单纯无创策略治疗，预后良好，而需要有创治疗的患者死亡风险增加了两倍。未来需要进行前瞻性随机试验，以比较有创和无创MV对AMI患者呼吸衰竭初始治疗方法的有效性。
