Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Respiratory and Critical Care Medicine, The Bishan Hospital of Chongqing, Chongqing, China.
Ther Adv Respir Dis. 2022 Jan-Dec;16:17534666221081042. doi: 10.1177/17534666221081042.
Use of noninvasive ventilation (NIV) in patients with moderate to severe ARDS is controversial. We aimed to use HACOR (combination of heart rate, acidosis, consciousness, oxygenation and respiratory rate) score to comprehensively assess the efficacy of NIV in ARDS patients with PaO/FiO ⩽ 150 mmHg.
Secondary analysis was performed using the data collected from two databases. We screened the ARDS patients who used NIV as a first-line therapy. Patients with PaO/FiO ⩽ 150 mmHg were enrolled. NIV failure was defined as requirement of intubation.
A total of 224 moderate to severe ARDS patients who used NIV as a first-line therapy were enrolled. Of them, 125 patients (56%) experienced NIV failure and received intubation. Among the intubated patients, the survivor had shorter time from initiation of NIV to intubation than nonsurvivors (median 10 vs 22 h, < 0.01). The median differences of HACOR score before and 1-2 h of NIV were 1 point (interquartile range: 0-3). We defined the patients with △HACOR >1 as responders (n = 102) and the rest to non-responders (n = 122). Compared to non-responders, the responders had higher HACOR score before NIV. However, the HACOR score was lower in the responders than non-responders after 1-2 h, 12 h, and 24 h of NIV. The responders also had lower NIV failure rate (36% vs 72%, < 0.01) and lower 28-day mortality (32% vs 47%, = 0.04) than non-responders.
NIV failure was high among patients with moderate to severe ARDS. Delayed intubation is associated with increased mortality. The reduction of HACOR score after 1-2 h of NIV can identify the patients who respond well to NIV.
在中重度 ARDS 患者中使用无创通气（NIV）存在争议。我们旨在使用 HACOR（心率、酸中毒、意识、氧合和呼吸频率的组合）评分综合评估 PaO/FiO₂≤150mmHg 的 ARDS 患者中 NIV 的疗效。
使用从两个数据库中收集的数据进行二次分析。我们筛选了使用 NIV 作为一线治疗的 ARDS 患者。纳入 PaO/FiO₂≤150mmHg 的患者。NIV 失败定义为需要插管。
共纳入 224 例使用 NIV 作为一线治疗的中重度 ARDS 患者。其中 125 例（56%）NIV 失败并接受插管。在插管患者中，幸存者从开始 NIV 到插管的时间短于非幸存者（中位数 10 与 22 小时，<0.01）。NIV 前和 1-2 小时 HACOR 评分的中位数差异为 1 分（四分位距：0-3）。我们将△HACOR>1 的患者定义为应答者（n=102），其余患者为无应答者（n=122）。与无应答者相比，应答者的 NIV 前 HACOR 评分更高。然而，在 1-2 小时、12 小时和 24 小时 NIV 后，应答者的 HACOR 评分低于无应答者。应答者的 NIV 失败率（36%比 72%，<0.01）和 28 天死亡率（32%比 47%，=0.04）也较低。
中重度 ARDS 患者中 NIV 失败率较高。延迟插管与死亡率增加有关。NIV 后 1-2 小时 HACOR 评分的降低可识别对 NIV 反应良好的患者。
