Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey.
Hacettepe University Medical Faculty, Department of Pulmonary Diseases, Ankara, Turkey.
Clin Respir J. 2020 Nov;14(11):1083-1089. doi: 10.1111/crj.13245. Epub 2020 Aug 27.
BACKGROUND-AIM: Noninvasive mechanical ventilation (NIV) failure rate is reported to be 5%-60% of intensive care unit (ICU) patients. Despite all precautions and well-known reasons, the risk factors of NIV failure are unclear for chronic obstructive pulmonary disease (COPD) with acute respiratory failure (ARF). The aim of this study was to examine risk factors for NIV failure in COPD patients with ARF, other than well defined.
The retrospective cohort study was done in ICU of a chest disease hospital. All consecutive COPD patients with hypercapnic ARF were enrolled in study. Demographics, comorbidities, arterial blood gases, reasons of ARF and length of ICU stay were recorded. NIV success was defined as discharge from ICU and NIV failure was defined as need for intubation or died during NIV. Patients were grouped into; NIV failure and success. The groups were compared and NIV failure risk factors were analyzed.
About 265 NIV success and 142 NIV failure patients were enrolled into the study. Logistic regression test showed the risk factors for NIV failure; higher APACHE-II (≥ 29) (OR:11.71, CI95%4.39-31.18, P < 0.001), culture positivity (OR:7.59, CI95%3.21-17.92, P < 0.001), sepsis (OR:6.53 CI95%3.59-11.85, P < 0.001) and pneumonia (OR:3.71 CI95%0.60-2.02, P < 0.043) significantly. COPD patients using home-based NIV had less risk for NIV failure (OR: 0.49 CI95%0.28-0.87, P < 0.014).
APACHE II ≥ 29 score, culture positivity, sepsis and pneumonia are the risk factors for NIV failure in COPD patients with ARF. COPD patients previously on home-based NIV showed half times less risk for NIV failure.
有报道称，在接受重症监护病房（ICU）治疗的患者中，无创机械通气（NIV）的失败率为 5%-60%。尽管采取了所有预防措施和已知的原因，但对于伴有急性呼吸衰竭（ARF）的慢性阻塞性肺疾病（COPD）患者，NIV 失败的风险因素仍不清楚。本研究旨在探讨除明确原因外，COPD 合并 ARF 患者发生 NIV 失败的危险因素。
这是一项在胸部疾病医院 ICU 进行的回顾性队列研究。所有因高碳酸血症性 ARF 而连续入住 ICU 的 COPD 患者均被纳入研究。记录患者的人口统计学、合并症、动脉血气、ARF 原因和 ICU 住院时间。将 NIV 成功定义为从 ICU 出院，NIV 失败定义为需要插管或在 NIV 期间死亡。将患者分为 NIV 成功和失败两组。对两组进行比较，并分析 NIV 失败的危险因素。
共有 265 例 NIV 成功和 142 例 NIV 失败患者纳入研究。Logistic 回归检验显示，NIV 失败的危险因素为：APACHE-II 评分较高（≥29）（OR：11.71，95%CI95%4.39-31.18，P<0.001）、培养阳性（OR：7.59，95%CI95%3.21-17.92，P<0.001）、脓毒症（OR：6.53，95%CI95%3.59-11.85，P<0.001）和肺炎（OR：3.71，95%CI95%0.60-2.02，P<0.043）。在家中使用 NIV 的 COPD 患者发生 NIV 失败的风险较低（OR：0.49，95%CI95%0.28-0.87，P<0.014）。
APACHE II≥29 评分、培养阳性、脓毒症和肺炎是 COPD 合并 ARF 患者 NIV 失败的危险因素。在家中使用过 NIV 的 COPD 患者发生 NIV 失败的风险减半。
