Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona, United States of America.
Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, The University of Arizona College of Medicine, Tucson, Arizona, United States of America.
PLoS One. 2024 Sep 6;19(9):e0307849. doi: 10.1371/journal.pone.0307849. eCollection 2024.
Noninvasive respiratory support modalities are common alternatives to mechanical ventilation in acute hypoxemic respiratory failure. However, studies historically compare noninvasive respiratory support to conventional oxygen rather than mechanical ventilation. In this study, we compared outcomes in patients with acute hypoxemic respiratory failure treated initially with noninvasive respiratory support to patients treated initially with invasive mechanical ventilation.
This is a retrospective observational cohort study between January 1, 2018 and December 31, 2019 at a large healthcare network in the United States. We used a validated phenotyping algorithm to classify adult patients (≥18 years) with eligible International Classification of Diseases codes into two cohorts: those treated initially with noninvasive respiratory support or those treated invasive mechanical ventilation only. The primary outcome was time-to-in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders. Secondary outcomes included time-to-hospital discharge alive. A secondary analysis was conducted to examine potential differences between noninvasive positive pressure ventilation and nasal high flow.
During the study period, 3177 patients met inclusion criteria (40% invasive mechanical ventilation, 60% noninvasive respiratory support). Initial noninvasive respiratory support was not associated with a decreased hazard of in-hospital death (HR: 0.65, 95% CI: 0.35-1.2), but was associated with an increased hazard of discharge alive (HR: 2.26, 95% CI: 1.92-2.67). In-hospital death varied between the nasal high flow (HR 3.27, 95% CI: 1.43-7.45) and noninvasive positive pressure ventilation (HR 0.52, 95% CI 0.25-1.07), but both were associated with increased likelihood of discharge alive (nasal high flow HR 2.12, 95 CI: 1.25-3.57; noninvasive positive pressure ventilation HR 2.29, 95% CI: 1.92-2.74).
These data show that noninvasive respiratory support is not associated with reduced hazards of in-hospital death but is associated with hospital discharge alive.
在急性低氧性呼吸衰竭中，无创呼吸支持是机械通气的常见替代方法。然而，历史上的研究将无创呼吸支持与常规氧疗进行比较，而不是与机械通气进行比较。在这项研究中，我们比较了最初接受无创呼吸支持治疗的急性低氧性呼吸衰竭患者与最初接受有创机械通气治疗的患者的结局。
这是一项在美国一家大型医疗保健网络中进行的回顾性观察队列研究，时间为 2018 年 1 月 1 日至 2019 年 12 月 31 日。我们使用经过验证的表型算法将符合国际疾病分类编码的成年患者（≥18 岁）分为两组：最初接受无创呼吸支持治疗或仅接受有创机械通气治疗的患者。主要结局是使用经过潜在混杂因素调整的逆概率治疗加权 Cox 模型分析的住院内死亡时间。次要结局包括存活出院时间。进行了二次分析以检查无创正压通气和鼻高流量之间的潜在差异。
在研究期间，符合纳入标准的 3177 名患者（40%接受有创机械通气，60%接受无创呼吸支持）。最初的无创呼吸支持与住院内死亡的风险降低无关（HR：0.65，95%CI：0.35-1.2），但与存活出院的风险增加相关（HR：2.26，95%CI：1.92-2.67）。鼻高流量（HR 3.27，95%CI：1.43-7.45）和无创正压通气（HR 0.52，95%CI 0.25-1.07）之间的住院内死亡情况有所不同，但两者都与存活出院的可能性增加相关（鼻高流量 HR 2.12，95CI：1.25-3.57；无创正压通气 HR 2.29，95%CI：1.92-2.74）。
这些数据表明，无创呼吸支持与降低住院内死亡风险无关，但与存活出院有关。
