Urgancı Özge Akdemir, Altuncı Yusuf Ali, Uz İlhan, Akarca Funda Karbek
Department of Emergency Medicine, Ege University Faculty of Medicine, Izmir, Türkiye.
Turk J Emerg Med. 2025 Jan 2;25(1):47-54. doi: 10.4103/tjem.tjem_128_24. eCollection 2025 Jan-Mar.
The aim of this study was to evaluate the factors associated with non-invasive mechanical ventilation (NIMV) failure in acute cardiogenic pulmonary edema (ACPE) diagnosed in the emergency department.
This study was prospectively conducted at the Ege University Faculty of Medicine ED between February 19, 2021 and December 01, 2021. Patients who received NIMV with ACPE were included. Patients' clinical and laboratory parameters, treatments, NIMV mode, and settings were recorded. The primary endpoint was NIMV failure (intubation within 24 h). Secondary endpoints were early NIMV failure, early mortality (within 24 h), and in-hospital mortality. Early NIMV failure was defined as follows: if the patient had a respiratory rate of more than 25 per minute, oxygen saturation below 90%, PaCO >50 mmHg in blood gas, and pH <7.35, 1 h after starting NIMV.
Out of 347 patients in this study, 34 (10.7%) of them intubated within 24 h. Female sex percentage was 48.7%. Median age was 73 years. Risk factors for NIMV failure were respiratory rate >40.5, systolic blood pressure <122.5 mmHg, Glasgow Coma Score <14, pH <7.21, lactate level >5.2 mmol/L, base excess <-4.5 mmol/L, B-type natriuretic peptide level >3007 pg/mL (respectively area under the curve values; 0.723, 0.693, 0.739, 0.721, 0.690, 0.698, and 0.616).
Signs of hypoperfusion such as low systolic blood pressure (<122.5 mmHg) and high lactate (lactate level >5.2 mmol/L) are risk factors for NIMV failure. Evaluation of initial vital signs and arterial blood gas parameters is significantly important for prediction of NIMV success in ED.
本研究旨在评估急诊科诊断的急性心源性肺水肿（ACPE）患者无创机械通气（NIMV）失败的相关因素。
本研究于2021年2月19日至2021年12月1日在伊兹密尔埃杰大学医学院急诊科前瞻性开展。纳入接受NIMV治疗的ACPE患者。记录患者的临床和实验室参数、治疗情况、NIMV模式及设置。主要终点为NIMV失败（24小时内插管）。次要终点为早期NIMV失败、早期死亡率（24小时内）和院内死亡率。早期NIMV失败定义如下：开始NIMV 1小时后，患者呼吸频率>25次/分钟、氧饱和度<90%、血气分析中PaCO>50 mmHg且pH<7.35。
本研究的347例患者中，34例（10.7%）在24小时内插管。女性占比48.7%。中位年龄为73岁。NIMV失败的危险因素包括呼吸频率>40.5、收缩压<122.5 mmHg、格拉斯哥昏迷评分<14、pH<7.21、乳酸水平>5.2 mmol/L、碱剩余<-4.5 mmol/L、B型利钠肽水平>3007 pg/mL（曲线下面积值分别为；0.723、0.693、0.739、0.721、0.690、0.698和0.616）。
低收缩压（<122.5 mmHg）和高乳酸（乳酸水平>5.2 mmol/L）等灌注不足迹象是NIMV失败的危险因素。评估初始生命体征和动脉血气参数对预测急诊科NIMV成功至关重要。
