慢性呼吸衰竭患者中无创通气（NIV）转换为持续气道正压通气（CPAP）的实际应用评估。一项病例对照研究。
Real-life evaluation of NIV to CPAP switch in patients with chronic respiratory failure. A case control study.
作者信息
Mathieu Louise, Rabec Claudio, Beltramo Guillaume, Aho Serge, Tankere Pierre, Schenesse Déborah, Chorvoz Jade, Bonniaud Philippe, Georges Marjolaine
机构信息
Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France.
Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; INSERM LNC-UMR 1231, Dijon, France.
出版信息
Respir Med Res. 2024 Nov;86:101114. doi: 10.1016/j.resmer.2024.101114. Epub 2024 May 2.
BACKGROUND
Non-invasive ventilation (NIV) is a standard of care for hypercapnic chronic respiratory failure (CRF). Obstructive sleep apnea syndrome (OSA) frequently contributes to hypoventilation in CRF patients. CPAP improves hypercapnia in selected COPD and obese patients, like NIV. We aimed to describe the profile of patients switching from NIV to CPAP in a cohort of patients on long-term ventilation and to identify the factors associated with a successful switch.
METHODS
In this case-control study, 88 consecutive patients who were candidates for a NIV-CPAP switch were compared with 266 controls among 394 ventilated patients treated at the Dijon University Hospital between 2015 and 2020. They followed a standardized protocol including a poly(somno)graphy recorded after NIV withdrawal for three nights. CPAP trial was performed if severe OSA was confirmed. Patients were checked for recurrent hypoventilation after 1 and 23[14-46] nights under CPAP.
RESULTS
Patients were 53% males, median age 65 [56-74] years, and median BMI 34 [25-38.5] kg/m. Sixty four percent of patients were safely switched and remained on long-term CPAP. In multivariate analysis, the probability of a NIV-CPAP switch was correlated to older age (OR: 1.3 [1.01-1.06]), BMI (OR: 1.7 [1.03-1.12]), CRF etiology (OR for COPD: 20.37 [4.2-98,72], OR for obesity: 7.31 [1.58-33.74]), circumstances of NIV initiation (OR for acute exacerbation: 11.64 [2.03-66.62]), lower pressure support (OR: 0.90 [0.73-0.92]), lower baseline PaCO (OR: 0.85 [0.80-0.91]) and lower compliance (OR: 0.76 [0.64-0.90]). Among 72 patients who went home under CPAP, pressure support level was the only factor associated with the outcome of the NIV-CPAP switch, even ) with a non-linear correlation. Etiology of chronic respiratory failure, age, BMI, baseline PaCO, circumstances of NIV initiation, time under home NIV or NIV compliance were not predictive of the outcome of the NIV-CPAP switch.
CONCLUSIONS
A NIV-CPAP switch is possible in real life conditions in stable obese and COPD patients with underlying OSA.
背景
无创通气（NIV）是高碳酸血症慢性呼吸衰竭（CRF）的标准治疗方法。阻塞性睡眠呼吸暂停综合征（OSA）常导致CRF患者通气不足。持续气道正压通气（CPAP）与NIV一样，可改善部分慢性阻塞性肺疾病（COPD）和肥胖患者的高碳酸血症。我们旨在描述一组长期接受通气治疗的患者从NIV转换为CPAP的情况，并确定与成功转换相关的因素。
方法
在这项病例对照研究中，将第戎大学医院2015年至2020年期间接受通气治疗的394例患者中连续88例有NIV转换为CPAP指征的患者与266例对照进行比较。他们遵循标准化方案，包括在停用NIV后连续三晚进行多导睡眠图记录。如果确诊为重度OSA，则进行CPAP试验。在CPAP治疗1晚和23[14 - 46]晚后检查患者是否反复出现通气不足。
结果
患者中男性占53%，中位年龄65[56 - 74]岁，中位体重指数（BMI）为（34[25 - 38.5]kg/m²）。64%的患者成功转换并长期使用CPAP。多因素分析显示，NIV转换为CPAP的概率与年龄较大（比值比[OR]：1.3[1.01 - 1.06]）、BMI（OR：1.7[1.03 - 1.12]）、CRF病因（COPD的OR：20.37[4.2 - 98.72]，肥胖的OR：7.31[1.58 - 33.74]）、NIV开始的情况（急性加重的OR：11.64[2.03 - 66.62]）、较低的压力支持（OR：0.90[0.73 - 0.92]）、较低的基线动脉血二氧化碳分压（PaCO₂）（OR：0.85[0.80 - 0.91]）和较低依从性（OR：0.76[0.64 - 0.90]）相关。在72例回家接受CPAP治疗的患者中，压力支持水平是与NIV转换为CPAP结果相关的唯一因素，即使是呈非线性相关。慢性呼吸衰竭的病因、年龄、BMI、基线PaCO₂、NIV开始的情况、家庭NIV治疗时间或NIV依从性均不能预测NIV转换为CPAP的结果。
结论
对于合并潜在OSA的稳定肥胖和COPD患者，在现实生活条件下从NIV转换为CPAP是可行的。
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