Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama 6 Road, Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
BMC Emerg Med. 2020 Oct 7;20(1):80. doi: 10.1186/s12873-020-00376-1.
Non-invasive mechanical ventilation (NIV) has become an alternative to an invasive artificial airway for the management of acute respiratory failure (ARF). NIV failure causes delayed intubation, which eventually has been associated with increased morbidity and mortality. This study aimed to develop the clinical scoring system of NIV failure in ARF patients.
This study was a diagnostic, retrospectively cross-sectional, and exploratory model at the Emergency Medicine Department in Ramathibodi Hospital between February 2017 and December 2017. We included all of the acute respiratory failure patients aged > 18 years and received non-invasive ventilation (NIV). Clinical factors associated with NIV failure were recorded. The predictive model and prediction score for NIV failure were developed by multivariable logistic regression analysis.
A total of 329 acute respiratory failure patients have received NIV success (N = 237) and failure (N = 92). This study showed that NIV failure was associated with heart rate > 110 bpm, systolic BP < 110 mmHg, SpO2 < 90%, arterial pH < 7.30 and serum lactate. The clinical scores were classified into three groups: low, moderate, and high.
We suggested that the novel clinical scoring of the NIV failure in this study may use as a good predictor for NIV failure in the emergency room.
无创机械通气（NIV）已成为急性呼吸衰竭（ARF）管理中替代有创人工气道的方法。NIV 失败会导致延迟插管，最终与发病率和死亡率的增加相关。本研究旨在为 ARF 患者开发 NIV 失败的临床评分系统。
这是一项在 2017 年 2 月至 12 月期间在 Ramathibodi 医院急诊科进行的诊断性、回顾性、横断探索性研究。我们纳入了所有年龄大于 18 岁并接受无创通气（NIV）的急性呼吸衰竭患者。记录与 NIV 失败相关的临床因素。通过多变量逻辑回归分析开发了 NIV 失败的预测模型和预测评分。
共有 329 例急性呼吸衰竭患者接受了 NIV 成功（N=237）和失败（N=92）。本研究表明，NIV 失败与心率>110bpm、收缩压<110mmHg、SpO2<90%、动脉 pH<7.30 和血清乳酸有关。临床评分分为三组：低、中、高。
我们建议，本研究中 NIV 失败的新临床评分可作为急诊科 NIV 失败的良好预测指标。
