Intensive Care Unit, Westmead Hospital, Westmead, NSW 2145, Australia.
University of Sydney, Intensive Care Unit, Westmead, Australia.
Aust Crit Care. 2020 Jan;33(1):89-96. doi: 10.1016/j.aucc.2018.11.067. Epub 2019 Jan 19.
Failure of Non-Invasive Ventilation (NIV) is associated with increased morbidity and mortality among critically ill patients. Although there is evidence of association between disease related factors and NIV failure, it is unclear whether factors related to NIV application contribute to NIV failure.
To evaluate NIV failure rate and factors associated with NIV failure.
DESIGN, SETTINGS AND OUTCOMES: Prospective, observational, pilot study conducted in a 23-bed, tertiary care Intensive Care Unit (ICU). NIV failure was defined as application of NIV resulting in intubation or death in ICU.
Amongst 238 patients admitted with respiratory failure, NIV was administered to 60 patients (34 males, 26 females) for a total of 70 application episodes. The etiology of respiratory failure included acute pulmonary edema (28.6%), acute lung injury (22.9%) and pneumonia (15.7%). The mean (SD) age was 62 (17.6) years, BMI 32.0 (8.5) kg/m and median APACHE-II score 17.5 (14.0-23.8). NIV failure occurred in 22 out of 70 applications (31.4% [95%CI 20.0-43.0]). NIV failure assessed by simple logistic regression analysis, was associated with admission diagnosis (OR 6.0, 95%CI: 1.3-28.7, p = 0.03), use of bi-level NIV-PS (OR 5.00, 95%CI: 1.04-24.1, p = 0.04), presence of nasogastric tube (OR 6.20, 95%CI: 1.9-19.8, p < 0.01) and with short NIV breaks in the 2nd 24-hours (OR 0.96, 95%CI: 0.91-0.99, p = 0.04).
NIV failure was observed in 31.4%. Factors associated with NIV failure were etiology of respiratory illness, type of NIV support and short NIV breaks, presumably reflecting illness severity or progress of disease. The presence of a nasogastric tube during application of NIV may adversely impact NIV application.
无创通气 (NIV) 失败与危重症患者的发病率和死亡率增加有关。尽管有证据表明疾病相关因素与 NIV 失败之间存在关联，但尚不清楚与 NIV 应用相关的因素是否会导致 NIV 失败。
评估 NIV 失败率和与 NIV 失败相关的因素。
设计、地点和结果：前瞻性、观察性、试点研究在一家 23 张床位的三级护理重症监护病房 (ICU) 进行。NIV 失败的定义为应用 NIV 导致 ICU 内插管或死亡。
在因呼吸衰竭而住院的 238 名患者中，有 60 名患者（34 名男性，26 名女性）接受了 NIV 治疗，共进行了 70 次应用。呼吸衰竭的病因包括急性肺水肿 (28.6%)、急性肺损伤 (22.9%) 和肺炎 (15.7%)。平均 (SD) 年龄为 62 (17.6) 岁，BMI 为 32.0 (8.5) kg/m2，中位数 APACHE-II 评分为 17.5 (14.0-23.8)。70 次应用中有 22 次（31.4% [95%CI 20.0-43.0]）发生 NIV 失败。通过简单的逻辑回归分析评估的 NIV 失败与入院诊断（OR 6.0，95%CI：1.3-28.7，p=0.03）、使用双水平 NIV-PS（OR 5.00，95%CI：1.04-24.1，p=0.04）、存在鼻胃管（OR 6.20，95%CI：1.9-19.8，p<0.01）和第 2 个 24 小时内 NIV 中断时间较短（OR 0.96，95%CI：0.91-0.99，p=0.04）有关。
NIV 失败发生率为 31.4%。与 NIV 失败相关的因素是呼吸疾病的病因、NIV 支持类型和 NIV 中断时间较短，这可能反映了疾病的严重程度或疾病的进展。在应用 NIV 期间存在鼻胃管可能会对 NIV 的应用产生不利影响。
