Moretto Francesca, Fracazzini Martina, Verdina Federico, Ferrante Daniela, Baino Sara, Grossi Francesca, Castello Luigi, Cammarota Gianmaria, Balbo Piero, Sainaghi Pier Paolo, Campanini Mauro, Pirisi Mario, Patti Giuseppe, Dal Molin Alberto, Della Corte Francesco, Navalesi Paolo, Vaschetto Rosanna
Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy.
Unit of Medical Statistics, Department of Translational Medicine, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, Novara, Italy.
Respir Care. 2022 Aug 24;67(9):1138-1146. doi: 10.4187/respcare.09625.
Noninvasive respiratory support (NRS) has been used to treat acute respiratory failure outside the ICU, but existing data have left many knowledge gaps for managing NRS in general wards. The primary objective of this study was to describe indications, duration of treatment, and outcomes of subjects treated with NRS outside the ICU. The secondary objective was to compare outcomes based on age < 80 or ≥ 80 y.
This retrospective observational study was conducted at Maggiore della Carità University Hospital in Novara, Italy, and included all patients treated with noninvasive ventilation (NIV) or CPAP outside the ICU from November 2017 to October 2018, with 1 year of follow-up.
Of the 570 treatments performed, 383 subjects were analyzed, 136 NIV and 247 CPAP. Subjects' median (interquartile range [IQR]) age was 79 (72-85) y, and the main diagnoses of respiratory failure were cardiogenic pulmonary edema in 128 subjects (33%), pneumonia in 99 (26%), and COPD exacerbation in 52 (14%), with a median (IQR) treatment duration of 38 (16-74) h. Rapid response team visits lasted a median (IQR) 3 (2-6) d. Interface-related pressure lesions occurred in 13% of the subjects, in no case leading to definitive treatment discontinuation. Compared with the subjects ≥ 80 y old, the younger subjects had a median (IQR) longer hospitalization (16 [10-24] d vs 13 [9-20] d; = .003) but slightly decreased in-hospital mortality (21% vs 30%; = .061) and a decreased post-discharged 1-year mortality in hospital survivors (25% vs 41%; = .002), differences observed only in the subjects treated with NIV.
In a real-life setting outside the ICU, NIV and CPAP managed by a rapid response team with a daily visit in collaboration with ward staff highly experienced in NRS allowed us to treat the subjects without major complications. Post-discharge 1-year mortality was higher in the subjects ≥ 80 y old treated with NIV for acute hypercapnic respiratory failure.
无创呼吸支持（NRS）已被用于治疗重症监护病房（ICU）以外的急性呼吸衰竭，但现有数据在普通病房管理NRS方面留下了许多知识空白。本研究的主要目的是描述在ICU以外接受NRS治疗的受试者的适应症、治疗持续时间和结局。次要目的是比较年龄＜80岁或≥80岁受试者的结局。
这项回顾性观察性研究在意大利诺瓦拉的马焦雷慈善大学医院进行，纳入了2017年11月至2018年10月在ICU以外接受无创通气（NIV）或持续气道正压通气（CPAP）治疗且随访1年的所有患者。
在进行的570次治疗中，对383名受试者进行了分析，其中136例接受NIV，247例接受CPAP。受试者的年龄中位数（四分位间距[IQR]）为79（72 - 85）岁，呼吸衰竭的主要诊断为心源性肺水肿128例（33%）、肺炎99例（26%）、慢性阻塞性肺疾病（COPD）加重52例（14%），治疗持续时间中位数（IQR）为38（16 - 74）小时。快速反应小组的探访持续时间中位数（IQR）为3（2 - 6）天。13%的受试者出现了与接口相关的压力性损伤，无一例导致最终停止治疗。与≥80岁的受试者相比，年龄较小的受试者住院时间中位数（IQR）更长（16[10 - 24]天对13[9 - 20]天；P = 0.003），但院内死亡率略有降低（21%对30%；P = 0.061），住院存活者出院后1年死亡率降低（25%对41%；P = 0.002），这些差异仅在接受NIV治疗的受试者中观察到。
在ICU以外的实际环境中，由快速反应小组管理并与在NRS方面经验丰富的病房工作人员每日协作进行的NIV和CPAP，使我们能够在无重大并发症的情况下治疗受试者。接受NIV治疗急性高碳酸血症性呼吸衰竭的≥80岁受试者出院后1年死亡率更高。
