Pulmonary Institute, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
BMJ Open Respir Res. 2022 Nov;9(1). doi: 10.1136/bmjresp-2022-001267.
Non-invasive ventilation (NIV) is effective in a variety of acute respiratory illnesses in hospitalised patients. Home NIV is effective for stable patients with hypercapnia due to neuromuscular or chronic pulmonary disease. However, there are little data to guide which patients may benefit from NIV immediately following hospitalisation with hypercapnia.
To evaluate outcomes of patients with daytime hypercapnia at the end of an acute hospital admission.
Retrospective cohort study.
Entry into the cohort was by querying the hospital electronic medical system for consultations regarding NIV after discharge. Cases received NIV and controls did not. We extracted data on demographics, ICD-9 diagnoses and medications coded at admission, blood gas measurements and dates of discharge, first readmission and death.
None.
Time from hospital discharge to mortality or readmission.
We identified 585 cases and 53 controls who survived to discharge at the index admission. Cases and controls were broadly similar in age and Charlson Comorbidity Index. In the whole cohort, cases treated with home NIV were at increased risk of death compared with controls (HR 1.88 95% CI 1.17 to 3.03). In multivariate Cox regression for all-cause mortality, poor prognostic factors were increasing age (HR 1.03 per year, 95% CI 1.02 to 1.04), cardiac failure (HR 1.31, 95% CI 1.01 to 1.67) and failure to attend NIV follow-up (HR 2.33, 95% CI 1.33 to 4.10). In contrast, chronic respiratory disease was associated with improved prognosis (HR 0.77, 95% CI 0.61 to 0.97) as was sleep apnoea (HR 0.44, 95% CI 0.23 to 0.83). Cases did not have different time-to-readmission compared with controls (HR 1.42 95% CI 0.99 to 2.02).
Transitioning to home NIV after a hypercapnic hospitalisation may be useful in younger, co-operative patients with chronic respiratory disease. For older patients or those with cardiac failure, home NIV may not be beneficial and may potentially be harmful.
无创通气（NIV）在住院患者的各种急性呼吸道疾病中有效。家庭 NIV 对因神经肌肉或慢性肺部疾病导致高碳酸血症的稳定患者有效。然而，几乎没有数据可以指导哪些患者在因高碳酸血症住院后立即受益于 NIV。
评估急性住院患者高碳酸血症末期患者的结局。
回顾性队列研究。
通过查询医院电子医疗系统中关于出院后 NIV 咨询的信息，将患者纳入队列。病例接受了 NIV，对照组则没有。我们提取了入院时的人口统计学、ICD-9 诊断和药物编码、血气测量以及出院、首次再入院和死亡日期的数据。
无。
从出院到死亡或再入院的时间。
我们确定了 585 例病例和 53 例对照组，他们在指数入院时存活至出院。病例和对照组在年龄和 Charlson 合并症指数方面大致相似。在整个队列中，与对照组相比，接受家庭 NIV 治疗的病例死亡风险增加（HR 1.88，95%CI 1.17 至 3.03）。在所有原因死亡率的多变量 Cox 回归中，预后不良的因素包括年龄增加（每增加 1 年 HR 为 1.03，95%CI 为 1.02 至 1.04）、心力衰竭（HR 为 1.31，95%CI 为 1.01 至 1.67）和未能参加 NIV 随访（HR 为 2.33，95%CI 为 1.33 至 4.10）。相比之下，慢性呼吸系统疾病与改善的预后相关（HR 为 0.77，95%CI 为 0.61 至 0.97），睡眠呼吸暂停也与改善的预后相关（HR 为 0.44，95%CI 为 0.23 至 0.83）。与对照组相比，病例的再入院时间没有差异（HR 为 1.42，95%CI 为 0.99 至 2.02）。
在因高碳酸血症住院的患者中，过渡到家庭 NIV 可能对年轻、合作的慢性呼吸系统疾病患者有用。对于老年患者或心力衰竭患者，家庭 NIV 可能无益，甚至可能有害。
