慢性阻塞性肺疾病急性加重患者机械通气的全球评估。VENTILAGROUP随时间的分析。一项回顾性多中心研究。

A worldwide assessment of the mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease. Analysis of the VENTILAGROUP over time. A retrospective, multicenter study.

作者信息

Peñuelas Oscar, Del Campo-Albendea Laura, Morales-Quinteros Luis, Muriel Alfonso, Nin Nicolás, Thille Arnaud, Du Bin, Pinheiro Bruno, Ríos Fernando, Marín María Carmen, Maggiore Salvatore, Raymondos Konstantinos, González Marco, Bersten Andrew, Amin Pravin, Cakar Nahit, Suh Gee Young, Abroug Fekri, Jibaja Manuel, Matamis Dimitros, Zeggwagh Amine Ali, Sutherasan Yuda, Artigas Antonio, Anzueto Antonio, Esteban Andrés, Frutos-Vivar Fernando, Del Sorbo Lorenzo

机构信息

Intensive Care UnitCentro de Investigación en Red de Enfermedades Respiratorias (CIBERES)Department of Medicine, Faculty of Medicine, Health and Sport, Hospital Universitario de Getafe, Universidad Europea de Madrid, Carretera de Toledo Km 12.5, 28905, Madrid, Spain.

Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain.

出版信息

Respir Res. 2024 Dec 18;25(1):434. doi: 10.1186/s12931-024-03037-0.

DOI:10.1186/s12931-024-03037-0

PMID:39696494

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11656863/

Abstract

BACKGROUND

The trend over time and across different geographical areas of outcomes and management with noninvasive ventilation or invasive mechanical ventilation in patients admitted for acute exacerbations of chronic obstructive pulmonary disease and treated with ventilatory support is unknown. The purpose of this study was to describe outcomes and identify variables associated with survival for patients admitted to an intensive care unit (ICU) with acute exacerbation of chronic obstructive pulmonary disease [aeCOPD] who received noninvasive or invasive mechanical ventilation worldwide.

METHODS

Retrospective, multi-national, and multicenter studies, including four observational cohort studies, were carried out in 1998, 2004, 2010, and 2016 for the VENTILAGROUP following the same methodology.

RESULTS

A total of 1,848 patients from 1,253 ICUs in 38 countries admitted for aeCOPD and need of ventilatory support were identified in the four study cohorts and included in the study. The overall incidence of aeCOPD as a cause for ventilatory support at ICU admission significantly decreased over time and varied widely according to the gross national income. The mortality of patients admitted to ICU for aeCOPD and ventilatory support significantly decreased over time regardless of the geographical area and gross national income; however, there is a remarkable variability in ICU mortality according to geographical area and gross national income. The use of NPPV as the first attempt at ventilatory support has significantly increased over time, with a parallel reduction of invasive mechanical ventilation regardless of gross national income.

CONCLUSION

In this worldwide observational study, including four sequential cohorts of patients over 18 years from 1998 to 2016, the mortality of patients admitted to ICU for aeCOPD and ventilatory support significantly decreased regardless of the geographical area and gross national income. Future research will need to investigate the reason for the remarkable variability in ICU mortality according to the geographical area, gross national income, and methods to select patients for the appropriate ventilatory support.

摘要

背景

慢性阻塞性肺疾病急性加重患者接受无创通气或有创机械通气治疗后的结局及管理随时间推移和不同地理区域的变化趋势尚不清楚。本研究的目的是描述全球范围内因慢性阻塞性肺疾病急性加重（aeCOPD）入住重症监护病房（ICU）并接受无创或有创机械通气患者的结局，并确定与生存相关的变量。

方法

VENTILAGROUP于1998年、2004年、2010年和2016年按照相同方法开展了回顾性、多国、多中心研究，包括四项观察性队列研究。

结果

在四项研究队列中，共识别出38个国家1253个ICU的1848例因aeCOPD入院且需要通气支持的患者，并纳入研究。aeCOPD作为ICU入院时通气支持原因的总体发生率随时间显著下降，且根据国民总收入差异很大。因aeCOPD入住ICU并接受通气支持患者的死亡率随时间显著下降，无论地理区域和国民总收入如何；然而，ICU死亡率根据地理区域和国民总收入存在显著差异。随着时间的推移，作为通气支持首次尝试的无创正压通气（NPPV）的使用显著增加，同时有创机械通气的使用相应减少，无论国民总收入如何。