Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome Insights from the LUNG SAFE Study

被引：399

作者：

Bellani, Giacomo ^{[1
,2
]}

Laffey, John G. ^{[3
,4
,5
,6
,7
,8
]}

Tai Pham ^{[11
,12
,13
]}

Madotto, Fabiana ^{[14
]}

Fan, Eddy ^{[9
,10
,15
]}

Brochard, Laurent ^{[4
,5
,8
,10
]}

Esteban, Andres ^{[16
]}

Gattinoni, Luciano ^{[17
]}

Bunnbasirevic, Vesna ^{[18
,19
]}

Piquilloud, Lise ^{[20
,21
]}

van Haren, Frank ^{[22
,23
]}

Larsson, Anders ^{[24
]}

McAuley, Daniel F. ^{[25
,26
]}

Bauer, Philippe R. ^{[27
]}

Arabi, Yaseen M. ^{[28
,29
]}

Ranieri, Marco ^{[30
]}

Antonelli, Massimo ^{[31
]}

Rubenfeld, Gordon D. ^{[8
,10
,32
]}

Thompson, B. Taylor ^{[33
]}

Wrigge, Hermann ^{[34
]}

Slutsky, Arthur S. ^{[5
,8
,10
]}

Pesenti, Antonio ^{[35
,36
]}

机构：

[1] Univ Milano Bicocca, Dept Med & Surg, Monza, Italy

[2] San Gerardo Hosp, Dept Emergency & Intens Care, Monza, Italy

[3] St Michaels Hosp, Dept Anesthesia, Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[4] St Michaels Hosp, Dept Crit Care Med, Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[5] St Michaels Hosp, Keenan Res Ctr Biomed Sci, Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[6] Univ Toronto, Dept Anesthesia, Toronto, ON, Canada

[7] Univ Toronto, Dept Physiol, Toronto, ON, Canada

[8] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[9] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[10] Univ Toronto, Dept Med, Toronto, ON, Canada

[11] Hop Tenon, AP HP, Grp Hosp Hop Univ Est Parisien, Unite Reanimat Medicochirurg,Pole Thorax Voies Ae, Paris, France

[12] Univ Paris Diderot, Unite Mixte Rech 1153, INSERM, Sorbonne Paris Cite,Epidemiol Clin & Stat,Rech Sa, Paris, France

[13] Univ Paris 06, Sorbonne Univ, Paris 06, France

[14] Univ Milano Bicocca, Res Ctr Publ Hlth, Dept Med & Surg, Milan, Italy

[15] Univ Hlth Network, Dept Med, Toronto, ON, Canada

[16] Hosp Univ Getafe, Ctr Invest Biorned Red Enfermedades Resp, Madrid, Spain

[17] Univ Med Ctr Gottingen, Dept Anesthesiol Emergency & Intens Care Med, Gottingen, Germany

[18] Univ Belgrade, Sch Med, Belgrade, Serbia

[19] Clin Ctr Serbia, Emergency Ctr, Dept Anesthesia & Intens Care, Belgrade, Serbia

[20] Univ Lausanne Hosp, Adult Intens Care & Bum Unit, Lausanne, Switzerland

[21] Univ Hosp Angers, Dept Med Intens Care, Angers, France

[22] Canberra Hosp, Intens Care Unit, Canberra, ACT, Australia

[23] Australian Natl Univ, Canberra, ACT, Australia

[24] Uppsala Univ, Dept Surg Sci, Sect Anesthesiol & Intens Care, Uppsala, Sweden

[25] Queens Univ Belfast, Ctr Expt Med, Wellcome Wolfson Inst Expt Med, Belfast, Antrim, North Ireland

[26] Royal Victoria Hosp, Reg Intens Care Unit, Belfast, Antrim, North Ireland

[27] Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA

[28] King Saud Bin Abdulaziz Univ Hlth Sci, Riyadh, Saudi Arabia

[29] King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia

[30] Sapienza Univ Roma, Policlin Umberto I, Dipartimento Anestesia & Rianimaz, Rome, Italy

[31] Univ Cattolica Sacro Cuore, Ist Anestesiol & Rianimaz, Fdn Policlin Univ A Gemelli, Rome, Italy

[32] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[33] Harvard Med Sch, Div Pulm & Crit Care, Massachusetts Gen Hosp, Dept Med, Boston, MA USA

[34] Univ Leipzig, Dept Anesthesiol & Intens Care Med, Leipzig, Germany

[35] Osped Maggiore Policlin, Dipartimento Anestesia Rianimaz & Emergenza Urgen, Fdn Ist Ricovero & Cura Carattere Sci Ca Granda, Milan, Italy

[36] Univ Milan, Dipartimento Fisiopatol Med Chirurg & Traplanti, Milan, Italy

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2017年 / 195卷 / 01期

关键词：

noninvasive ventilation; acute respiratory distress syndrome; POSITIVE-PRESSURE VENTILATION; OBSTRUCTIVE PULMONARY-DISEASE; REANIMATION ONCO-HEMATOLOGIQUE; CRITICALLY-ILL PATIENTS; BERLIN DEFINITION; AIRWAY PRESSURE; FAILURE; METAANALYSIS; MALIGNANCIES; EXACERBATIONS;

D O I：

10.1164/rccm.201606-1306OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse. Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the Pa-O2/FIO2 Berlin criteria is useful. Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of thePa(O2)/FIO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome. Measurements and Main Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severitybased on PaolFio, ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159-1.805D, but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a Pa-O2/FIO2 lower than 150 mm Hg. Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a Pa-O2/FIO2 lower than 150 mm Hg.

引用

页码：67 / 77

页数：11

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