Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Crit Care Med. 2024 Nov 1;52(11):1739-1749. doi: 10.1097/CCM.0000000000006400. Epub 2024 Aug 21.
To determine whether mortality differed between initial invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) followed by delayed IMV in immunocompromised patients with sepsis.
Retrospective analysis using the National Data Center for Medical Service claims data in China from 2017 to 2019.
A total of 3530 hospitals across China.
A total of 36,187 adult immunocompromised patients with sepsis requiring ventilation.
None.
The primary outcome was hospital mortality. Patients were categorized into NIV initiation or IMV initiation groups based on first ventilation. NIV patients were further divided by time to IMV transition: no transition, immediate (≤ 1 d), early (2-3 d), delayed (4-7 d), or late (≥ 8 d). Mortality was compared between groups using weighted Cox models. Over the median 9-day follow-up, mortality was similar for initial NIV versus IMV (adjusted hazard ratio [HR] 1.006; 95% CI, 0.959-1.055). However, among NIV patients, a longer time to IMV transition is associated with stepwise increases in mortality, from immediate transition (HR 1.65) to late transition (HR 2.51), compared with initial IMV. This dose-response relationship persisted across subgroups and sensitivity analyses.
Prolonged NIV trial before delayed IMV transition is associated with higher mortality in immunocompromised sepsis patients ultimately intubated.
确定免疫功能低下的脓毒症患者初始有创机械通气（IMV）或无创通气（NIV）后延迟 IMV 的死亡率是否存在差异。
使用中国 2017 年至 2019 年国家医疗服务数据中心的数据进行回顾性分析。
中国共有 3530 家医院。
共纳入 36187 例需要通气的免疫功能低下的脓毒症成年患者。
无。
主要结局为医院死亡率。根据首次通气将患者分为 NIV 起始或 IMV 起始组。NIV 患者进一步根据向 IMV 过渡的时间进行分组：无过渡、即刻（≤1d）、早期（2-3d）、延迟（4-7d）或晚期（≥8d）。使用加权 Cox 模型比较组间死亡率。在中位数为 9 天的随访期间，初始 NIV 与 IMV 的死亡率相似（调整后的危险比 [HR]1.006；95%CI，0.959-1.055）。然而，在 NIV 患者中，与初始 IMV 相比，向 IMV 过渡的时间延长与死亡率呈逐步增加相关，从即刻过渡（HR1.65）到晚期过渡（HR2.51）。这种剂量-反应关系在亚组和敏感性分析中均存在。
免疫功能低下的脓毒症患者最终插管前长时间进行 NIV 试验与延迟 IMV 过渡后死亡率升高相关。
