Department of Respiratory and Critical Care, No.37 Guoxue Alley, Chengdu, 610041, China.
Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Pulm Med. 2017 Sep 15;17(1):125. doi: 10.1186/s12890-017-0469-4.
Sedation and/or analgesia can relieve the patient-ventilator asynchrony. However, whether sedation and/or analgesia can benefit the clinical outcome of the patients with interface intolerance is still unclear.
A retrospective study was performed on patients with interface intolerance who received noninvasive positive pressure ventilation (NIPPV) after extubation in seven intensive care units (ICU) of West China Hospital, Sichuan University. The primary outcome was rate of NIPPV failure (defined as need for reintubation and mechanical ventilation); Secondary outcomes were hospital mortality rate and length of ICU stay after extubation.
A total of 80 patients with oral-nasal mask (90%) and facial mask (10%) were included in the analysis. 41 out of 80 patients received sedation and/or analgesia treatment (17 used analgesia, 11 used sedation and 13 used both) at some time during NIPPV. They showed a decrease of NIPPV failure rate, (15% vs. 38%, P = 0.015; adjusted odd ratio [OR] 0.29, 95% confidence interval [CI] 0.10-0.86, P = 0.025), mortality rate (7% vs. 33%, P = 0.004; adjusted OR 0.14, 95% CI 0.03-0.60, P = 0.008), and the length of ICU stay after extubation.
This clinical study suggests that sedation and/or analgesia treatment can decrease the rate of NIPPV failure, hospital mortality rate and ICU LOS in patients with interface intolerance after extubution during NIPPV.
镇静和/或镇痛可以缓解患者-呼吸机不同步。然而，镇静和/或镇痛是否能使接口不耐受患者的临床结局获益尚不清楚。
对四川大学华西医院 7 个重症监护病房（ICU）中接受经鼻/面罩（90%）和鼻罩（10%）无创正压通气（NIPPV）治疗的接口不耐受患者进行回顾性研究。主要结局是 NIPPV 失败率（定义为需要重新插管和机械通气）；次要结局是拔管后 ICU 病死率和 ICU 住院时间。
共纳入 80 例患者，其中 41 例（51.3%）患者在 NIPPV 期间接受了镇静和/或镇痛治疗（17 例使用镇痛，11 例使用镇静，13 例同时使用）。与未接受镇静和/或镇痛治疗的患者相比，接受镇静和/或镇痛治疗的患者 NIPPV 失败率降低（15%比 38%，P=0.015；调整后比值比[OR]0.29，95%置信区间[CI]0.10-0.86，P=0.025），病死率降低（7%比 33%，P=0.004；调整后 OR 0.14，95%CI 0.03-0.60，P=0.008），拔管后 ICU 住院时间缩短。
这项临床研究表明，镇静和/或镇痛治疗可降低接口不耐受患者拔管后接受 NIPPV 治疗时 NIPPV 失败率、院内病死率和 ICU 住院时间。
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