Hukins Craig, Wong Mimi, Murphy Michelle, Upham John
Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2017 Jul;47(7):784-792. doi: 10.1111/imj.13403.
There are limited data on outcomes of hypoxaemic respiratory failure (HRF), especially in non-intensive care unit (ICU) settings.
To assess outcomes in HRF (without multi-system disease and not requiring early intubation) of patients directly admitted to a Respiratory High-dependency Unit (R-HDU).
This is a retrospective cohort study of HRF compared to hypercapnic respiratory failure (HCRF) in a R-HDU (2007-2011). Patient characteristics (age, gender, pre-morbid status, diagnoses) and outcomes (non-invasive ventilation (NIV) use, survival, ICU admission) were assessed.
There were 1207 R-HDU admissions in 2007-2011, 205 (17%) with HRF and 495 (41%) with HCRF. The proportion with HRF increased from 12.2% in 2007 to 20.1% in 2011 (P < 0.05). HRF patients were younger, more often male and had better pre-morbid performance. Compared to HCRF, HRF was more frequently associated with lung consolidation (61% vs 15%, P < 0.001), interstitial lung disease (12% vs 1%, P < 0.001) and pulmonary hypertension (7% vs 0%, P < 0.001) and less frequently with chronic obstructive pulmonary disease (24% vs 65%, P < 0.001) and obstructive sleep apnoea (8% vs 26%, P < 0.001). Fewer patients with HRF were treated with NIV (28% vs 87%, P < 0.001), but NIV was discontinued early more often (28% vs 7%, P < 0.001). A total of 18% with HRF was transferred to ICU compared to 6% with HCRF (P = 0.06). More patients with HRF died (19.5% vs 12.3%, P = 0.02). Interstitial lung disease, consolidation, shock, malignancy and poorer pre-morbid function were associated with increased mortality.
Initial R-HDU management is an effective option in selected HRF to reduce ICU demand, although mortality and clinical deterioration despite NIV are more common than in HCRF.
关于低氧性呼吸衰竭（HRF）的预后数据有限，尤其是在非重症监护病房（ICU）环境中。
评估直接入住呼吸高依赖病房（R-HDU）的HRF患者（无多系统疾病且无需早期插管）的预后。
这是一项对R-HDU中HRF与高碳酸血症性呼吸衰竭（HCRF）进行比较的回顾性队列研究（2007 - 2011年）。评估了患者特征（年龄、性别、病前状态、诊断）和预后（无创通气（NIV）使用情况、生存率、入住ICU情况）。
2007 - 2011年共有1207例患者入住R-HDU，其中205例（17%）为HRF，495例（41%）为HCRF。HRF患者的比例从2007年的12.2%增至2011年的20.1%（P < 0.05）。HRF患者更年轻，男性更常见，病前状况更好。与HCRF相比，HRF更常与肺实变（61%对15%，P < 0.001）、间质性肺疾病（12%对1%，P < 0.001）和肺动脉高压（7%对0%，P < 0.001）相关，而与慢性阻塞性肺疾病（24%对65%，P < 0.001）和阻塞性睡眠呼吸暂停（8%对26%，P < 0.001）的相关性较低。接受NIV治疗的HRF患者较少（28%对87%，P < 0.001），但NIV更早停用的情况更常见（28%对7%，P < 0.001）。HRF患者中有18%转入ICU，而HCRF患者为6%（P = 0.06）。HRF患者死亡更多（19.5%对12.3%，P = 0.02）。间质性肺疾病、实变、休克、恶性肿瘤和较差的病前功能与死亡率增加相关。
对于部分HRF患者，R-HDU的初始管理是减少ICU需求的有效选择，尽管与HCRF相比，NIV治疗期间死亡率和临床恶化情况更常见。
