Abe Tatsuhiko, Takagi Toshishige, Takahashi Kazunari, Yagi Kosuke, Tsuge Ai, Fujii Tomoko
Department of Intensive Care Jikei University Hospital Tokyo Japan.
Department of Clinical Engineering Technology Jikei University Hospital Tokyo Japan.
Health Sci Rep. 2023 Dec 11;6(12):e1757. doi: 10.1002/hsr2.1757. eCollection 2023 Dec.
The timing of transition from non-invasive ventilation (NIV) to invasive ventilation in the intensive care unit (ICU) is uncertain due to a lack of clinical evidence. This study aimed to identify the optimal timing of intubation in patients with respiratory failure managed with NIVs.
A single-center observational study was conducted in Tokyo, Japan. Patients in the ICU managed with NIV between 2013 and 2022 were screened. The primary outcome was 28-day invasive ventilator-free days. Statistical analyses used locally estimated scatter plot smoothing (LOESS) and generalized linear mixed models to estimate the association between the timing of transition and prolonged intubation duration.
During the study period, 139 of 589 adult ICU patients receiving NIV transitioned to invasive ventilation. The LOESS curve indicated the longest 28-day ventilator-free days around 24 h after NIV initiation, after which the primary outcome decreased linearly. Late intubation after 24 h of NIV initiation was associated with fewer 28-day ventilator-free days (adjusted mean difference: -0.22 days [95% confidence interval: -0.31, -0.13]).
We identified a non-linear association between the timing of intubation and 28-day invasive ventilator-free days. The critical 24-h time window for patients on NIV was associated with longer 28-day invasive ventilator-free days.
由于缺乏临床证据，重症监护病房（ICU）中从无创通气（NIV）转换为有创通气的时机尚不确定。本研究旨在确定接受无创通气治疗的呼吸衰竭患者的最佳插管时机。
在日本东京进行了一项单中心观察性研究。对2013年至2022年间在ICU接受无创通气治疗的患者进行筛选。主要结局是28天无有创通气天数。统计分析采用局部加权散点平滑法（LOESS）和广义线性混合模型来估计转换时机与延长插管持续时间之间的关联。
在研究期间，589例接受无创通气的成年ICU患者中有139例转换为有创通气。LOESS曲线显示，在无创通气开始后约24小时左右，28天无通气天数最长，此后主要结局呈线性下降。无创通气开始24小时后延迟插管与28天无通气天数减少相关（调整后平均差异：-0.22天[95%置信区间：-0.31，-0.13]）。
我们确定了插管时机与28天无有创通气天数之间存在非线性关联。无创通气患者的关键24小时时间窗与更长的28天无有创通气天数相关。
