Failure of Noninvasive Ventilation for De Novo Acute Hypoxemic Respiratory Failure: Role of Tidal Volume

被引:337
作者
Carteaux, Guillaume [1 ,2 ,3 ]
Millan-Guilarte, Teresa [4 ]
De Prost, Nicolas [1 ,2 ,3 ]
Razazi, Keyvan [1 ,2 ,3 ]
Abid, Shariq [3 ]
Thille, Arnaud W. [5 ,6 ]
Schortgen, Frederique [1 ,3 ]
Brochard, Laurent [3 ,7 ,8 ,9 ]
Brun-Buisson, Christian [1 ,2 ,10 ]
Dessap, Armand Mekontso [1 ,2 ,3 ]
机构
[1] CHU Henri Mondor, AP HP, DHU A TVB, Serv Reanimat Med, F-94010 Creteil, France
[2] Univ Paris Est Creteil, Fac Med Creteil, Grp Rech Clin CARMAS, Creteil, France
[3] Hop Henri Mondor, INSERM, IMRB, Unite U955, F-94010 Creteil, France
[4] Hosp Univ Son Espases, Unidad Cuidados Intens, Palma De Mallorca, Spain
[5] CHU Poitiers, Serv Reanimat Med, Poitiers, France
[6] CHU Poitiers, ALIVE Grp, CIC P 1402, Poitiers, France
[7] St Michaels Hosp, Keenan Res Ctr, Toronto, ON M5B 1W8, Canada
[8] St Michaels Hosp, Crit Care Dept, Toronto, ON M5B 1W8, Canada
[9] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
[10] Inst Pasteur, INSERM, U657, Pharmacoepidemiol & Malad Infect, F-75724 Paris, France
关键词
acute lung injury; acute respiratory distress syndrome; noninvasive ventilation; pneumonia; respiratory insufficiency; tidal volume; PRESSURE SUPPORT VENTILATION; COMMUNITY-ACQUIRED PNEUMONIA; CARDIOGENIC PULMONARY-EDEMA; HIGH AIRWAY PRESSURE; MECHANICAL VENTILATION; DISTRESS-SYNDROME; PROTECTIVE-VENTILATION; LUNG INJURY; PERMEABILITY; MORTALITY;
D O I
10.1097/CCM.0000000000001379
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: A low or moderate expired tidal volume can be difficult to achieve during noninvasive ventilation for de novo acute hypoxemic respiratory failure (i.e., not due to exacerbation of chronic lung disease or cardiac failure). We assessed expired tidal volume and its association with noninvasive ventilation outcome. Design: Prospective observational study. Setting: Twenty-four bed university medical ICU. Patients: Consecutive patients receiving noninvasive ventilation for acute hypoxemic respiratory failure between August 2010 and February 2013. Interventions: Noninvasive ventilation was uniformly delivered using a simple algorithm targeting the expired tidal volume between 6 and 8 mL/kg of predicted body weight. Measurements: Expired tidal volume was averaged and respiratory and hemodynamic variables were systematically recorded at each noninvasive ventilation session. Main Results: Sixty-two patients were enrolled, including 47 meeting criteria for acute respiratory distress syndrome, and 32 failed noninvasive ventilation (51%). Pneumonia (n = 51, 82%) was the main etiology of acute hypoxemic respiratory failure. The median (interquartile range) expired tidal volume averaged over all noninvasive ventilation sessions (mean expired tidal volume) was 9.8 mL/kg predicted body weight (8.1-11.1 mL/kg predicted body weight). The mean expired tidal volume was significantly higher in patients who failed noninvasive ventilation as compared with those who succeeded (10.6 mL/kg predicted body weight [9.6-12.0] vs 8.5 mL/kg predicted body weight [7.6-10.2]; p = 0.001), and expired tidal volume was independently associated with noninvasive ventilation failure in multivariate analysis. This effect was mainly driven by patients with Pao(2)/Fio(2) up to 200 mm Hg. In these patients, the expired tidal volume above 9.5 mL/kg predicted body weight predicted noninvasive ventilation failure with a sensitivity of 82% and a specificity of 87%. Conclusions: A low expired tidal volume is almost impossible to achieve in the majority of patients receiving noninvasive ventilation for de novo acute hypoxemic respiratory failure, and a high expired tidal volume is independently associated with noninvasive ventilation failure. In patients with moderate-to-severe hypoxemia, the expired tidal volume above 9.5 mL/kg predicted body weight accurately predicts noninvasive ventilation failure.
引用
收藏
页码:282 / 290
页数:9
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