Luo Zujin, Han Fusheng, Li Yichong, He Hangyong, Yang Gen, Mi Yuhong, Ma Yingmin, Cao Zhixin
Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing 100043, China.
Emergency Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China.
J Crit Care. 2017 Jun;39:238-247. doi: 10.1016/j.jcrc.2017.01.001. Epub 2017 Jan 6.
We identified risk factors for noninvasive ventilation (NIV) failure in patients with acute cardiogenic pulmonary edema (ACPE).
We conducted an observational cohort study over a 3-year period in a 28-bed emergency intensive care unit (EICU) and prospectively included all consecutive patients in whom NIV was attempted as initial ventilatory support for ACPE. The primary outcome variables were NIV failure rate and risk factors for NIV failure.
Among the 118 patients in the study, NIV failed for 44 (37.3%) patients. Risk factors for NIV failure were Killip class IV (odds ratio [OR], 28.56; 95% confidence interval [CI], 2.17-375.73; p=0.011), left ventricular ejection fraction (LVEF) <30% (OR, 9.54; 95% CI, 1.01-90.55; p=0.050) and B-type natriuretic peptide (BNP) ≥3350pg/mL (OR, 39.63; 95% CI, 3.92-400.79; p=0.002) at baseline, and fluid balance ≥400mL within 24h after ACPE (OR, 13.19; 95% CI, 1.18-147.70; p=0.036).
NIV failure occurred in 37.3% of ACPE patients in a real-world EICU. When patients had Killip class IV, a lower LVEF, a higher BNP, and a more positive fluid balance within 24h after ACPE, the risk of failure was higher. TRIAL REGISTRATION CLINICALTRIALS.
NCT02653365.
我们确定了急性心源性肺水肿（ACPE）患者无创通气（NIV）失败的危险因素。
我们在一个拥有28张床位的急诊重症监护病房（EICU）进行了一项为期3年的观察性队列研究，并前瞻性纳入了所有连续接受NIV作为ACPE初始通气支持的患者。主要结局变量为NIV失败率和NIV失败的危险因素。
在该研究的118例患者中，44例（37.3%）NIV失败。NIV失败的危险因素包括基线时Killip分级为IV级（比值比[OR]，28.56；95%置信区间[CI]，2.17 - 375.73；p = 0.011）、左心室射血分数（LVEF）<30%（OR，9.54；95% CI，1.01 - 90.55；p = 0.050）以及B型利钠肽（BNP）≥3350 pg/mL（OR，39.63；95% CI，3.92 - 400.79；p = 0.002），以及ACPE后24小时内液体平衡≥400 mL（OR，13.19；95% CI，1.18 - 147.70；p = 0.036）。
在实际的EICU中，37.3%的ACPE患者出现NIV失败。当患者有Killip分级IV级、较低的LVEF、较高的BNP以及ACPE后24小时内更明显的液体正平衡时，失败风险更高。试验注册：CLINICALTRIALS.GOV标识符：NCT02653365。
