Chen Wei-Chih, Su Vincent Yi-Fong, Yu Wen-Kuang, Chen Yen-Wen, Yang Kuang-Yao
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS One. 2018 Jan 12;13(1):e0191204. doi: 10.1371/journal.pone.0191204. eCollection 2018.
Few studies have reported outcomes of lung cancer patients with acute respiratory failure (RF) using noninvasive positive pressure ventilation (NIPPV). The aim of this study was to investigate the prognostic factors in these patients.
This retrospective observational study included all hospitalized lung cancer patients who received NIPPV for acute RF. It was conducted at a tertiary medical center in Taiwan from 2005 to 2010. The primary outcome was all cause mortality at 28 days after the initiation of NIPPV. Secondary outcomes included all-cause in-hospital mortality, weaning from NIPPV, intubation rate, tracheostomy rate, duration of NIPPV, hospital stay and intensive care unit stay.
The all-cause mortality rate at day 28 of the enrolled 58 patients was 39.66%. The 90-day and 1-year mortality rates were 63.79% and 86.21%, respectively. NIPPV as the first line therapy for RF had higher 28-day mortality rate than it used for post-extubation RF (57.6% versus 16.0%, p<0.05). Independent predictors of mortality at 28 days were progressive disease or newly diagnosed lung cancer (OR 14.02 95% CI 1.03-191.59, p = 0.048), combined with other organ failure (OR 18.07 95% CI 1.87-172.7, p = 0.012), and NIPPV as the first line therapy for RF (OR 35.37 95% CI 3.30-378.68, p = 0.003).
Lung cancer patients using NIPPV with progressive or newly diagnosed cancer disease, combined with other organ failure, or NIPPV as the first line therapy for respiratory failure have a poor outcome.
很少有研究报道使用无创正压通气（NIPPV）治疗急性呼吸衰竭（RF）的肺癌患者的预后情况。本研究旨在调查这些患者的预后因素。
这项回顾性观察研究纳入了所有因急性RF接受NIPPV治疗的住院肺癌患者。研究于2005年至2010年在台湾的一家三级医疗中心进行。主要结局是开始NIPPV治疗后28天的全因死亡率。次要结局包括全因院内死亡率、NIPPV撤机情况、插管率、气管切开率、NIPPV使用时长、住院时间和重症监护病房住院时间。
纳入的58例患者在第28天的全因死亡率为39.66%。90天和1年死亡率分别为63.79%和86.21%。NIPPV作为RF的一线治疗，其28天死亡率高于用于拔管后RF的情况（57.6%对16.0%，p<0.05）。28天死亡率的独立预测因素为疾病进展或新诊断的肺癌（比值比14.02，95%置信区间1.03 - 191.59，p = 0.048）、合并其他器官衰竭（比值比18.07，95%置信区间1.87 - 172.7，p = 0.012）以及NIPPV作为RF的一线治疗（比值比35.37，95%置信区间3.30 - 378.68，p = 0.003）。
使用NIPPV治疗的肺癌患者，若患有进展性或新诊断的癌症疾病、合并其他器官衰竭，或NIPPV作为呼吸衰竭的一线治疗，预后较差。
