Department of Emergency Medicine, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Servei de Pneumologia, Hospital Corporació Parc Tauli de Sabadell, Barcelona, Spain.
Eur J Intern Med. 2019 Jan;59:21-26. doi: 10.1016/j.ejim.2018.09.025. Epub 2018 Oct 25.
Non-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital mortality.
Prospective, observational study performed in 19 centers in Italy. Patients with ARF due to pneumonia treated outside the ICU with either continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period of at least 3 consecutive months in 2013. Independent factors related to in-hospital mortality were evaluated.
Among the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7%) patients,NPPV in 171 (49.3%). The NPPV compared with CPAP group showed a significant higher PaCO (55 [47-78] vs 37 [32-43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21-7.37] vs 7.43 [7.35-7.47], p < 0.001), higher HCO3- (28 [24-33] vs 24 [21-27] mmol/L, p < 0.001). De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001). In-hospital mortality was 23% (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity Index (CCI) ≥3 were independent risk factors for in-hospital mortality.
Outside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal status (DNI status, CCI) rather than the baseline degree of ARF.
无创通气（NIV）是治疗某些急性呼吸衰竭（ARF）的标准治疗方法。关于其在肺炎中的应用的数据缺乏，尤其是在重症监护病房（ICU）之外的环境中。本研究的目的是评估 NIV 在 ICU 之外的肺炎所致 ARF 中的应用，并确定院内死亡率的危险因素。
这是一项在意大利 19 个中心进行的前瞻性、观察性研究。2013 年，至少连续 3 个月内，在这些中心中招募了因肺炎导致 ARF 且在 ICU 之外接受持续气道正压通气（CPAP）或无创正压通气（NPPV）治疗的患者。评估了与院内死亡率相关的独立因素。
在纳入的 347 名患者中，176 名（50.7%）患者首先接受 CPAP 治疗，171 名（49.3%）患者首先接受 NPPV 治疗。与 CPAP 组相比，NPPV 组的 PaCO2 更高（55[47-78] vs 37[32-43]mmHg，p<0.001），动脉 pH 值更低（7.30[7.21-7.37] vs 7.43[7.35-7.47]，p<0.001），HCO3-更高（28[24-33] vs 24[21-27]mmol/L，p<0.001）。CPAP 组新发 ARF 的发生率高于 NPPV 组（86/176 比 31/171 例，p<0.001）。院内死亡率为 23%（83/347）。不插管（DNI）医嘱和 Charlson 合并症指数（CCI）≥3 是院内死亡率的独立危险因素。
在 ICU 之外的环境中，CPAP 主要用于低氧血症而非高碳酸血症性 ARF，NPPV 用于高碳酸血症性 ARF。院内死亡率主要与患者的基础状态（DNI 状态、CCI）相关，而与 ARF 的基线严重程度无关。
