Sacco Alice, Montisci Andrea, Tavecchia Giovanni, Frea Simone, Bernasconi Davide, Colombo Costanza N J, Bertolin Stephanie, Viola Giovanna, Villanova Luca, Briani Martina, Patrini Lisa, Bocchino Pier Paolo, Sorini Dini Carlotta, D'Ettore Nicoletta, Bertaina Maurizio, Iannaccone Mario, Potena Luciano, Bertoldi Letizia, Valente Serafina, Camporotondo Rita, Marini Marco, Pagnesi Matteo, Metra Marco, De Ferrari Gaetano, Oliva Fabrizio, Morici Nuccia, Pappalardo Federico, Tavazzi Guido
Cardiac Intensive Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Division of Cardiothoracic Intensive Care, ASST Spedali Civili, Brescia, Italy.
Eur J Heart Fail. 2024 Nov;26(11):2412-2420. doi: 10.1002/ejhf.3409. Epub 2024 Aug 6.
To describe the use and the relation to outcome of different ventilation strategies in a contemporary, large, prospective registry of cardiogenic shock patients.
Among 657 patients enrolled from March 2020 to November 2023, 198 (30.1%) received oxygen therapy (OT), 96 (14.6%) underwent non-invasive ventilation (NIV), and 363 (55.3%) underwent invasive mechanical ventilation (iMV). Patients in the iMV group were significantly younger compared to those in the NIV and OT groups (63 vs. 69 years, p < 0.001). There were no significant differences between groups regarding cardiovascular risk factors. Patients with SCAI B and C were more frequently treated with OT and NIV compared to iMV (65.1% and 65.4% vs. 42.6%, respectively, p > 0.001), while the opposite trend was observed in SCAI D patients (12% and 12.2% vs. 30.9%, respectively, p < 0.001). All-cause mortality at 24 h did not differ amongst the three groups. The 60-day mortality rates were 40.2% for the iMV group, 26% for the OT group, and 29.3% for the NIV group (p = 0.005), even after excluding patients with cardiac arrest at presentation. In the multivariate analysis including SCAI stages, NIV was not associated with worse mortality compared to iMV (hazard ratio 1.97, 95% confidence interval 0.85-4.56), even in more severe SCAI stages such as D.
Compared to previous studies, we observed a rising trend in the utilization of NIV among cardiogenic shock patients, irrespective of aetiology and SCAI stages. In this clinical scenario, NIV emerges as a safe option for appropriately selected patients.
在一个当代大型前瞻性心源性休克患者登记研究中，描述不同通气策略的使用情况及其与预后的关系。
在2020年3月至2023年11月纳入的657例患者中，198例（30.1%）接受了氧疗（OT），96例（14.6%）接受了无创通气（NIV），363例（55.3%）接受了有创机械通气（iMV）。与NIV组和OT组相比，iMV组患者显著更年轻（63岁对69岁，p<0.001）。各组之间在心血管危险因素方面无显著差异。与iMV组相比，SCAI B和C级患者接受OT和NIV治疗的频率更高（分别为65.1%和65.4%对42.6%，p>0.001），而在SCAI D级患者中观察到相反的趋势（分别为12%和12.2%对30.9%，p<0.001）。三组患者24小时全因死亡率无差异。即使排除就诊时心脏骤停的患者，iMV组60天死亡率为40.2%，OT组为26%，NIV组为29.3%（p=0.005）。在包括SCAI分期的多变量分析中，与iMV相比，NIV与更高死亡率无关（风险比1.97，95%置信区间0.85-4.56），即使在更严重的SCAI分期如D期也是如此。
与先前研究相比，我们观察到心源性休克患者中NIV的使用呈上升趋势，无论病因和SCAI分期如何。在这种临床情况下，NIV成为适合选择患者的安全选择。
