The role of non-invasive positive pressure ventilation in patients with acute respiratory distress syndrome due to viral pneumonia / 中华急诊医学杂志

ABSTRACT

Objective:To explore the efficacy and case selection of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute respiratory distress syndrome (ARDS) caused by viral pneumonia.Methods:These patients who were continuously admitted in the Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from December 2017 to June 2019 and met the inclusion and exclusion criteria were enrolled in this prospective cohort study. All subjects accepted NIPPV as the initial intervention and they were divided into the NIPPV failure group and NIPPV success group according to the requirement of endotracheal intubation (ETI). Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors for NIPPV failure. Receiver operating characteristic (ROC) was plotted to evaluate the predictive value of risk factors for NIPPV failure in these patients.Results:Forty-three patients were studied in this experiment. The success rate of NIPPV was 62.8% (27/43), and the failure rate was 37.2% (16/43). Compared with the NIPPV success group, the incidence of nosocomial infection [44% (7/16) vs 0 (0/27), χ 2 =11.082, P<0.05] and mortality rate [50% (8/16) vs 7% (2/27), χ 2 =7.965, P<0.05] were significantly increased in the NIPPV failure group. The univariate analysis indicated that the acute physiology and chronic health evaluation II (APACHEⅡ) score, the ratio of early concurrent bacterial or fungal infections, and the proportion of patients with insufficient NIPPV at the early 72 h were significantly higher in the NIPPV failure group (all P<0.05). Meanwhile, multivariate logistic regression analysis identified that the baseline APACHEⅡ score ( OR=1.941, 95% CI1.159-3.249, P=0.012), the rate of early concurrent bacterial or fungal infections ( OR=8.602, 95% CI1.267-58.416, P=0.028), and insufficient use of NIPPV at the early 72 h ( OR=10.06, 95% CI1.592-63.527, P=0.014) were independent risk factors associated with NIPPV failure. The ROC curve showed the area under curve (AUC), the sensitivity, and the specificity was 0.748, 62.5%, and 74.1% respectively, which demonstrates that that APACHE Ⅱ score at admission was the most predictive factor of NIPPV failure. For the observed indicator without enough NIPPV treatment within 72 h, the AUC, the sensitivity, and the specificity was 0.714, 68.8%, and 74.1%, respectively. And for the observed indicator with concurrent bacterial or fungal infections, the AUC, the sensitivity and the specificity is 0.707, 56.3% and 85.2%, respectively. Conclusions:Early use of enough NIPPV in patients with ARDS caused by viral pneumonia can significantly decrease ETI and mortality rates. However, NIPPV should not be conducted in patients suffered from severe ARDS or early concurrent bacterial or fungal infections.