Tao Huang, Lijuan Chen, Xiaoyi Liu, Ke Wang, Weiwei Shu, Lei Jiang, Linfu Bai, Wenhui Hu, Mengyi Ma, Jun Duan
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引用次数: 0
Abstract
Background: Noninvasive ventilation (NIV) is frequently employed for acute hypoxemic respiratory failure, yet optimal intubation timing for high-risk NIV failure patients remains uncertain.
Objectives: To investigate mortality outcomes associated with early versus late intubation in high-risk NIV failure patients.
Design: Secondary analysis of a multicenter observational cohort study.
Methods: Patients with high NIV failure risk (updated HACOR score ⩾11 after 1-2 h of NIV) were enrolled. We defined that intubation was needed in these high-risk patients. Intubation occurring within 12 h of NIV initiation was classified as early intubation, while intubation after 12 h was designated as late intubation. Primary outcomes were intensive care unit (ICU) and hospital mortality. In sensitivity analyses, patients who achieved NIV success were categorized into the late-intubation group. Due to baseline imbalances, propensity score matching was performed with covariate adjustment.
Results: Among the study population, 171 patients underwent early intubation and 222 underwent late intubation. Despite greater baseline severity in the early intubation group, ICU mortality (36% vs 58%, p < 0.001) and hospital mortality (38% vs 58%, p < 0.001) were significantly lower compared to the late-intubation group. In sensitivity analyses, 190 patients with NIV success were included in the late-intubation group, further accentuating the severity disparity between groups. After propensity matching (220 patients: 110 per group), most of the baseline characteristics were comparable. The early intubation group had a 100% intubation rate versus 71% in the late-intubation group, with the latter exhibiting higher mortality (ICU: 46% vs 32%, p = 0.052; hospital: 50% vs 34%, p = 0.020).
Conclusion: In patients at high risk for NIV failure, early intubation is associated with reduced mortality.
背景：无创通气（NIV）常用于急性低氧血症性呼吸衰竭，但对高危无创通气失败患者的最佳插管时间仍不确定。目的：探讨高危无创通气失败患者早期与晚期插管相关的死亡率。设计：多中心观察队列研究的二次分析。方法：招募NIV失败风险高的患者（在NIV 1-2小时后更新HACOR评分大于或等于11）。我们确定这些高危患者需要插管。在NIV启动后12小时内插管被归类为早期插管，12小时后插管被归类为晚期插管。主要结局是重症监护病房（ICU）和住院死亡率。在敏感性分析中，获得NIV成功的患者被归类为晚期插管组。由于基线不平衡，倾向评分匹配进行协变量调整。结果：在研究人群中，早期插管171例，晚期插管222例。尽管早期插管组的基线严重程度更高，但ICU死亡率(36% vs 58%, p p p = 0.052；医院：50% vs 34%， p = 0.020)。结论：在NIV失效的高危患者中，早期插管可降低死亡率。
期刊介绍：
Therapeutic Advances in Respiratory Disease delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of respiratory disease.
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