Department of Respiratory Medicine and Respiratory Research Unit, Waikato Hospital, Hamilton, New Zealand
Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand.
BMJ Open Respir Res. 2022 May;9(1). doi: 10.1136/bmjresp-2021-001149.
Non-invasive ventilation (NIV), although effective in treating hypercapnic respiratory failure, has not demonstrated the same efficacy in treating acute hypoxaemic respiratory failure. We aimed to examine the effect of NIV use on ventilator-free days in patients with acute hypoxaemic respiratory failure admitted to the intensive care unit (ICU).
We conducted a retrospective study of patients admitted to the ICU with acute hypoxaemic respiratory failure at Waikato Hospital, New Zealand, from 1 January 2009 to 31 December 2018. Patients treated with NIV as the initial oxygenation strategy were compared with controls treated with early intubation. The two groups were matched using a propensity score based on baseline characteristics. The primary outcome was the number of ventilator-free days at day 28. The secondary outcomes were ICU and hospital length of stay and in-hospital mortality.
Out of 175 eligible patients, 79 each out of the NIV and early intubation groups were matched using a propensity score. Early NIV was associated with significantly higher median ventilator-free days than early intubation (17 days vs 23 days, p=0.013). There was no significant difference in median ICU length of stay (112.5 hours vs 117.7 hours), hospital length of stay (14 days vs 14 days) or in-hospital mortality (31.6% vs 37.9%) between the NIV and the early intubation group.
Compared with early intubation, NIV use was associated with more ventilator-free days in patients with hypoxaemic respiratory failure. However, this did not translate into a shorter length of stay or reduced mortality based on our single-centre experience.
虽然无创通气（NIV）在治疗高碳酸血症性呼吸衰竭方面有效，但在治疗急性低氧血症性呼吸衰竭方面并未显示出相同的疗效。我们旨在研究 NIV 在治疗入住重症监护病房（ICU）的急性低氧血症性呼吸衰竭患者中的应用对无呼吸机天数的影响。
我们对 2009 年 1 月 1 日至 2018 年 12 月 31 日期间在新西兰怀卡托医院因急性低氧血症性呼吸衰竭入住 ICU 的患者进行了回顾性研究。比较了以 NIV 作为初始氧合策略治疗的患者与早期插管治疗的对照组。两组患者均基于基线特征使用倾向评分匹配。主要结局是第 28 天的无呼吸机天数。次要结局是 ICU 和住院时长以及院内死亡率。
在 175 名符合条件的患者中，79 名接受 NIV 和早期插管的患者分别使用倾向评分匹配。早期 NIV 与早期插管相比，中位无呼吸机天数显著更高（17 天 vs 23 天，p=0.013）。两组 ICU 时长（112.5 小时 vs 117.7 小时）、住院时长（14 天 vs 14 天）或院内死亡率（31.6% vs 37.9%）无显著差异。
与早期插管相比，NIV 在低氧血症性呼吸衰竭患者中与更多的无呼吸机天数相关。然而，根据我们的单中心经验，这并未转化为更短的住院时长或降低死亡率。
