新型冠状病毒肺炎中级护理病房中与无创正压通气失败相关的因素。

Factors associated with non-invasive positive pressure ventilation failure in a COVID-19 intermediate care unit.

作者信息

Farinha Inês, da Cunha Alexandra Tenda, Nogueira Ana Rita, Ribeiro André, Silva Carlos, Rua João, Trêpa João, Mateus José Eduardo, Costa Filipa

机构信息

Pulmonology Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.

Intensive Care Medicine Department, Coimbra Hospital and University Centre, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.

出版信息

Int J Emerg Med. 2023 May 12;16(1):36. doi: 10.1186/s12245-023-00510-3.

DOI:10.1186/s12245-023-00510-3

PMID:37173632

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10175901/

Abstract

BACKGROUND

The use of non-invasive positive pressure ventilation (NIPPV) in COVID-19 patients with hypoxaemia is still under debate. The aim was to evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care Unit of Coimbra Hospital and University Centre, Portugal, and to assess factors associated with NIPPV failure.

METHODS

Patients admitted from December 1st 2020 to February 28th 2021, treated with NIPPV due to COVID-19 were included. Failure was defined as orotracheal intubation (OTI) or death during hospital stay. Factors associated with NIPPV failure were included in a univariate binary logistic regression analysis; those with a significance level of p < 0.001 entered a multivariate logistic regression model.

RESULTS

A total of 163 patients were included, 64.4% were males (n = 105). The median age was 66 years (IQR 56-75). NIPPV failure was observed in 66 (40.5%) patients, 26 (39.4%) were intubated and 40 (60.6%) died during their hospital stay. The highest CRP (OR 1.164; 95%CI 1.036-1.308) and morphine use (OR 24.771; 95%CI 1.809-339.241) were identified as predictors of failure after applying multivariate logistic regression. Adherence to prone positioning (OR 0.109; 95%CI 0.017-0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977; 95%CI 0.960-0.994) were associated with a favorable outcome.

CONCLUSIONS

NIPPV was successful in over half of patients. Highest CRP during hospital stay and morphine use were predictors of failure. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome.

摘要

背景

对于低氧血症的新型冠状病毒肺炎（COVID-19）患者使用无创正压通气（NIPPV）仍存在争议。目的是评估在葡萄牙科英布拉医院及大学中心专门的COVID-19中级护理病房接受治疗的COVID-19患者中，NIPPV（持续气道正压通气（CPAP）、头盔式CPAP或无创通气（NIV））的疗效，并评估与NIPPV失败相关的因素。

方法

纳入2020年12月1日至2021年2月28日因COVID-19接受NIPPV治疗的患者。失败定义为住院期间气管插管（OTI）或死亡。将与NIPPV失败相关的因素纳入单变量二元逻辑回归分析；显著性水平p < 0.001的因素进入多变量逻辑回归模型。

结果

共纳入163例患者，64.4%为男性（n = 105）。中位年龄为66岁（四分位间距56 - 75岁）。66例（40.5%）患者出现NIPPV失败，26例（39.4%）进行了气管插管，40例（60.6%）在住院期间死亡。应用多变量逻辑回归后，最高的C反应蛋白（CRP）（比值比（OR）1.164；95%置信区间（CI）1.036 - 1.308）和吗啡使用（OR 24.771；95%CI 1.809 - 339.241）被确定为失败的预测因素。坚持俯卧位（OR 0.109；95%CI 0.017 - 0.700）和住院期间最低血小板计数较高（OR 0.977；95%CI 0.960 - 0.994）与良好结局相关。