Bry Charlotte, Jaffré Sandrine, Guyomarc'h Béatrice, Corne Frédéric, Chollet Sylvaine, Magnan Antoine, Blanc François-Xavier
Service de pneumologie, l'institut du thorax, Centre Hospitalier Universitaire, Nantes, France.
Département Hospitalo-Universitaire 2020, médecine personnalisée des maladies chroniques, Nantes, France; INSERM, UMR1087, l'institut du thorax, Nantes, France; and CNRS, UMR 6291, Nantes, France.
Respir Care. 2018 Jan;63(1):28-35. doi: 10.4187/respcare.05302. Epub 2017 Oct 3.
Noninvasive ventilation (NIV) has been widely used to treat acute respiratory failure in obese patients. Criteria that could help clinicians to decide whether they should continue to use NIV after such an initial episode remain unclear. Our retrospective study aims to analyze characteristics of subjects receiving long-term NIV after an initial hospitalization for acute respiratory failure.
From January 2011 to December 2012, 77 obese adults were admitted in the ICU of the respiratory disease department in Nantes University Hospital in France. After discharge, adherence, body mass index (BMI), and arterial blood gases were assessed or measured at 6 months and 12 months.
In all, 53 subjects were analyzed, including 62% who were admitted for idiopathic acute hypercapnic respiratory failure. Mean BMI was 42 ± 11 kg/m. Failure of NIV occurred in 10% cases in the ICU. At the end of the hospital stay, 34 subjects were discharged with NIV at home. They had higher BMI and higher initial inspiratory positive airway pressure than those who were not ventilated at home. During follow-up, BMI, P , and bicarbonate rate significantly decreased. At 12 months, 4 subjects were not ventilated anymore after a mean duration of 6 ± 4.2 months of ventilation. Adherence was correct in 86%, with a mean use of 7 ± 3.1 h/d. Adherent subjects had better adherence at 1 month, a lower forced vital capacity, a higher bicarbonate rate, and a higher NIV breathing frequency when compared to subjects with poor adherence.
Subjects with the most severe obesity or who experienced the most difficult initial ventilation were more likely to receive long-term NIV after initial management of acute respiratory failure in the ICU. In those subjects, long-term NIV at home was effective and well tolerated.
无创通气（NIV）已被广泛用于治疗肥胖患者的急性呼吸衰竭。有助于临床医生决定在首次发作后是否应继续使用NIV的标准仍不明确。我们的回顾性研究旨在分析在首次因急性呼吸衰竭住院后接受长期NIV治疗的患者的特征。
2011年1月至2012年12月，77名肥胖成年人入住法国南特大学医院呼吸内科重症监护病房。出院后，在6个月和12个月时评估或测量依从性、体重指数（BMI）和动脉血气。
总共分析了53名受试者，其中62%因特发性急性高碳酸血症性呼吸衰竭入院。平均BMI为42±11kg/m²。在重症监护病房中，10%的病例无创通气失败。住院结束时，34名受试者在家中使用无创通气出院。他们的BMI和初始吸气气道正压高于未在家中进行通气的患者。在随访期间，BMI、PCO₂和碳酸氢盐率显著下降。在12个月时，4名受试者在平均通气6±4.2个月后不再进行通气。依从性良好的占86%，平均每天使用7±3.1小时。与依从性差的受试者相比，依从性好的受试者在1个月时依从性更好，用力肺活量更低，碳酸氢盐率更高，无创通气呼吸频率更高。
在重症监护病房对急性呼吸衰竭进行初始治疗后，肥胖最严重或初始通气最困难的患者更有可能接受长期无创通气。在这些患者中，在家中进行长期无创通气是有效的，且耐受性良好。
