Liu Baojuan, Ye Gen, Wang Ruirui, Song Feier, Hong Yimei, Huang Xiaoran, Hu Bei, Li Weifeng, Li Xin
Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Department of Emergency, Peking University Shenzhen Hospital, Shenzhen, China.
J Thorac Dis. 2024 Sep 30;16(9):5835-5845. doi: 10.21037/jtd-24-163. Epub 2024 Sep 19.
Hypoxemia is a common critical respiratory complication in patients with acute aortic dissection (AAD) before operation and results in adverse outcomes. This study aimed to identify the optimal oxygenation treatment for AAD patients with hypoxemia in the emergency department (ED).
This was a retrospective, observational, cohort study. We retrospectively collected data from 187 adult patients with AAD and hypoxemia who had been admitted to our ED. All patients were divided into nasal cannula group (n=91), Venturi mask group (n=60), and non-invasive positive pressure ventilation (NIPPV) group (n=36). The primary outcome was overall mortality in ED; the secondary outcomes were preoperative intubation rate and postoperative mortality, length of intensive care unit (ICU) stay, length of hospital stay, and length of intubation.
Among all patients, those who received NIPPV treatment showed the lowest ED intubation rate (2.78%, P=0.004), shortest postoperative length of ICU stay (median 2.31, P<0.001), postoperative length of intubation (median 25.10, P<0.001), and post-operative length of hospital stay (median 21.00, P<0.001). Kaplan-Meier analysis showed the highest 3-day survival (log-rank 7.387, P=0.03) and 5-day survival (log-rank 14.710, P=0.001) in the NIPPV group. After adjustment, NIPPV therapy was independently associated with the reduced 3-day [adjusted hazard ratio (HR) 0.102, 95% confidence interval (CI): 0.013-0.791, P=0.03] and 5-day (adjusted HR 0.057, 95% CI: 0.008-0.427, P=0.005) mortality in ED.
Early utilization of NIPPV in AAD patients with hypoxemia in the ED can effectively decrease pre-operative intubation rate and perioperative mortality, and improve postoperative outcomes.
低氧血症是急性主动脉夹层（AAD）患者术前常见的严重呼吸并发症，并导致不良后果。本研究旨在确定急诊科（ED）中AAD合并低氧血症患者的最佳氧疗方案。
这是一项回顾性观察队列研究。我们回顾性收集了187例入住我院急诊科的成年AAD合并低氧血症患者的数据。所有患者分为鼻导管组（n = 91）、文丘里面罩组（n = 60）和无创正压通气（NIPPV）组（n = 36）。主要结局是急诊科的总体死亡率；次要结局是术前插管率、术后死亡率、重症监护病房（ICU）住院时间、住院时间和插管时间。
在所有患者中，接受NIPPV治疗的患者急诊科插管率最低（2.78%，P = 0.004），术后ICU住院时间最短（中位数2.31，P < 0.001），术后插管时间（中位数25.10，P < 0.001），术后住院时间（中位数21.00，P < 0.001）。Kaplan-Meier分析显示NIPPV组3天生存率最高（对数秩检验7.387，P = 0.03）和5天生存率最高（对数秩检验14.710，P = 0.001）。调整后，NIPPV治疗与急诊科3天（调整后风险比[HR] 0.102，95%置信区间[CI]：0.013 - 0.791，P = 0.03）和5天（调整后HR 0.057，95% CI：0.008 - 0.427，P = 0.005）死亡率降低独立相关。
在急诊科对AAD合并低氧血症患者早期使用NIPPV可有效降低术前插管率和围手术期死亡率，并改善术后结局。
