Nam Hyunseung, Cho Jae Hwa, Choi Eun Young, Chang Youjin, Choi Won Il, Hwang Jae Joon, Moon Jae Young, Lee Kwangha, Kim Sei Won, Kang Hyung Koo, Sim Yun Su, Park Tai Sun, Park Seung Yong, Park Sunghoon
Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Tuberc Respir Dis (Seoul). 2019 Jul;82(3):242-250. doi: 10.4046/trd.2018.0064. Epub 2019 Feb 28.
Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea.
A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included.
A total of 156 patients treated with NIV were enrolled (mean age, 71.9±11.6 years). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non-pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV.
AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with respiratory failure.
在韩国，重症监护病房（ICU）中无创通气（NIV）使用的数据非常有限。
2017年6月至2018年2月，在大学附属医院的20个ICU进行了一项前瞻性观察研究。纳入入住ICU并接受无创通气治疗急性呼吸衰竭的成年患者（年龄>18岁）。
共纳入156例接受无创通气治疗的患者（平均年龄71.9±11.6岁）。无创通气最常见的适应证是急性高碳酸血症性呼吸衰竭（AHRF，n = 89）和拔管后呼吸衰竭（n = 44）。无创通气的主要设备是带有无创通气模块的有创机械通气机（61.5%），大多数患者（87.2%）使用口鼻面罩。排除32例放弃心肺复苏的患者后，无创通气成功率为68.5%（85/124）；ICU死亡率和医院死亡率分别为8.9%和15.3%。然而，与AHRF患者（72.8%）或拔管后呼吸衰竭患者（75.0%）相比，[此处原文可能有误，推测应为“慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭”之类表述]呼吸衰竭患者的成功率较低（27.3%）。多因素分析显示，免疫功能低下状态、[此处原文可能有误，推测应为“慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭”之类表述]呼吸衰竭、无创通气后（2小时）呼吸频率、无创通气模式（即非压力支持通气模式）以及无创通气设备的更换与无创通气成功率较低显著相关。
AHRF和拔管后呼吸衰竭是韩国ICU中无创通气最常见的适应证。总体而言，68.5%的患者无创通气成功，[此处原文可能有误，推测应为“慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭”之类表述]呼吸衰竭患者的成功率最低。
