1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
2 Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
Am J Respir Crit Care Med. 2017 Jan 1;195(1):67-77. doi: 10.1164/rccm.201606-1306OC.
Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse.
To determine whether, during NIV, the categorization of ARDS severity based on the Pa/Fi Berlin criteria is useful.
The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the Pa/Fi ratio in classifying patients receiving NIV, and the impact of NIV on outcome.
Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on Pa/Fi ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159-1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a Pa/Fi lower than 150 mm Hg.
NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a Pa/Fi lower than 150 mm Hg. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).
无创通气（NIV）在急性呼吸窘迫综合征（ARDS）患者中的应用越来越多。支持 NIV 在 ARDS 患者中应用的证据仍然相对较少。
确定在使用 NIV 时，基于 Pa/Fi 柏林标准的 ARDS 严重程度分类是否有用。
LUNG SAFE（了解全球严重急性呼吸衰竭影响的大型观察性研究）研究描述了 ARDS 患者的管理。本亚研究检查了 ARDS 患者中 NIV 使用的当前实践、Pa/Fi 比值在分类接受 NIV 的患者中的效用以及 NIV 对结局的影响。
在 2813 名 ARDS 患者中，有 436 名（15.5%）在符合诊断标准后的第 1 天和第 2 天接受了 NIV 治疗。基于 Pa/Fi 比值的 ARDS 严重程度分类与通气支持强度的增加、NIV 失败和重症监护病房（ICU）死亡率相关。轻度 ARDS 患者的 NIV 失败率为 22.2%，中度 ARDS 患者为 42.3%，重度 ARDS 患者为 47.1%。NIV 成功和失败患者的住院死亡率分别为 16.1%和 45.4%。NIV 使用与 ICU（危险比，1.446 [95%置信区间，1.159-1.805]）但不是医院死亡率相关。在倾向匹配分析中，Pa/Fi 低于 150mmHg 的 NIV 患者比接受有创通气的患者 ICU 死亡率更高。
NIV 被用于 15%的 ARDS 患者，无论严重程度如何。在 Pa/Fi 低于 150mmHg 的患者中，NIV 似乎与更高的 ICU 死亡率相关。临床试验在 www.clinicaltrials.gov 注册（NCT 02010073）。
