Valkó Luca, Baglyas Szabolcs, Tamáska Eszter, Lorx András, Gál János
Aneszteziológiai és Intenzív Terápiás Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Üllői út 78., 1085.
Orv Hetil. 2018 Nov;159(45):1831-1837. doi: 10.1556/650.2018.31052.
The use of noninvasive ventilation has increased worldwide. Its mortality reducing benefit has been shown in several different conditions compared to invasive ventilation. Common counterarguments against the technique are its increased technical and caregiver requirements and increased mortality associated with treatment failure.
The aim of our work was to describe our experiences with noninvasive ventilation in the intensive care unit.
We reviewed patient data from the Respiratory Intensive Care unit of Semmelweis University operated from 2014 to 2016. Statistical analysis was performed by Mann-Whitney U test and Z-test; odds ratio was calculated with χ-square test.
Out of the 301 patients analyzed, 147 received noninvasive ventilation. Noninvasive failure rate was 24.5%. The highest failure rate was associated with immunodeficiency associated pneumonia, interstitial lung disease and pneumonia (71.4%, 33.3% and 31.6%), while noninvasive ventilation was the most successful in cardiogenic pulmonary edema and hypercapnic respiratory failure (0 and 16.7% failure rate). Treatment failure was associated with significantly higher mortality (33.3%) compared to patients initially ventilated invasively (24.5%) and patients successfully treated with noninvasive ventilation (3.6%), resulting in a 2.65-fold mortality increase in invasively ventilated patients (OR = 2.65, 95% CI = 1.305-5.374, p = 0.009), and a 13.33-fold mortality increase in noninvasive failure patients (OR = 13.33; 95% CI 3.278-54.238; p<0.001). Outcome scores did not predict noninvasive failure.
Noninvasive ventilation is a widely used, effective treatment mode which can improve the outcome in certain diseases compared to invasive ventilation. Noninvasive ventilation in incorrect indications could, however, lead to increased failure rates and mortality. Orv Hetil. 2018; 159(45): 1831-1837.
无创通气在全球范围内的使用有所增加。与有创通气相比，其降低死亡率的益处已在几种不同情况下得到证实。针对该技术常见的反对意见是其对技术和护理人员的要求增加，以及与治疗失败相关的死亡率增加。
我们工作的目的是描述我们在重症监护病房使用无创通气的经验。
我们回顾了塞梅尔维斯大学呼吸重症监护病房2014年至2016年期间的患者数据。采用曼-惠特尼U检验和Z检验进行统计分析；用卡方检验计算比值比。
在分析的301例患者中，147例接受了无创通气。无创通气失败率为24.5%。最高失败率与免疫缺陷相关性肺炎、间质性肺疾病和肺炎相关（分别为71.4%、33.3%和31.6%），而无创通气在心源性肺水肿和高碳酸血症性呼吸衰竭中最为成功（失败率分别为0和16.7%）。与最初接受有创通气的患者（24.5%）和成功接受无创通气治疗的患者（3.6%）相比，治疗失败与显著更高的死亡率（33.3%）相关，导致有创通气患者死亡率增加2.65倍（比值比=2.65，95%置信区间=1.305 - 5.374，p = 0.009），无创通气失败患者死亡率增加13.33倍（比值比=13.33；95%置信区间3.278 - 54.238；p<0.001）。预后评分不能预测无创通气失败。
无创通气是一种广泛使用的有效治疗模式，与有创通气相比，在某些疾病中可改善预后。然而，在不恰当的适应症中使用无创通气可能导致失败率和死亡率增加。《匈牙利医学周报》2018年；159(45): 1831 - 1837。
